Association between preoperative interruption of antiplatelet therapy and postoperative thrombotic risk after minimally invasive surgery for abdominopelvic cancer in patients treated with P2Y12 inhibitors

TL;DR

Stopping antiplatelet drugs before minimally invasive cancer surgery increases the risk of heart-related issues without reducing bleeding or death.

Contribution

This study identifies increased postoperative coronary risks from discontinuing P2Y12 inhibitors before surgery.

Findings

Discontinuing antiplatelet therapy increased thrombotic complications (RR, 3.29).

Patients on dual antiplatelet therapy faced higher coronary artery disease risk (RR, 5.30).

No benefit in bleeding control or mortality was observed with therapy discontinuation.

Abstract

The safety of preoperative discontinuation of antiplatelet therapy for arterial thrombotic complications in non-cardiac, high-bleeding-risk surgery among patients receiving P2Y12 inhibitors remains poorly understood. This study compares the effect of preoperative discontinuation of antiplatelet therapy versus maintenance on thrombotic complications in patients receiving P2Y12 inhibitors who undergo minimally invasive surgery (MIS) for abdominal or pelvic cancer.

In this cohort study, we identified patients receiving P2Y12 inhibitors who underwent planned MIS for abdominopelvic cancer from two hospital-based databases. They were divided into an interruption (exposure) group that discontinued antiplatelet therapy 5 days before surgery and a maintenance (control) group that continued therapy based on confirmed prescriptions less than 5 days before surgery. After adjusting for confounders, we evaluated the weighted risk ratios (RRs) for postoperative interventions over 90 days.

A total of 1365 eligible patients were divided into an interruption group (n = 1157) and a maintenance group (n = 208). The interruption group had increased risk of thrombotic complications (RR, 3.29; 95% confidence interval (CI), 1.15 to 9.41), particularly in postoperative coronary artery disease (RR, 5.30; 95% CI, 1.27 to 22.12). This elevated risk was notable among patients receiving dual antiplatelet therapy preoperatively. The interruption group did not show increased risk of postoperative ischemic stroke or peripheral arterial disease, nor did it substantially differ in hemostasis procedures, blood transfusions, or mortality. Notably, patients who discontinued antiplatelet therapy exhibited a higher overall risk of vascular events (RR, 2.54; 95% CI, 1.16 to 5.56).

Discontinuing antiplatelet therapy in patients receiving P2Y12 inhibitors more than 5 days before MIS was associated with an increased risk of postoperative coronary artery disease, without providing any benefit in terms of bleeding control or mortality.

The online version contains supplementary material available at 10.1186/s12916-026-04634-0.

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