Safety of cholecystectomy in patients under antithrombotic Drugs: A systematic review and meta-analysis

OBJECTIVE: This review aimed to assess evidence on the safety of cholecystectomy in patients under antithrombotic therapy. METHODS: PubMed, Embase, Science Direct, CENTRAL, and Google Scholar databases were searched from inception up to 20(th) January 2022 for studies comparing outcomes of patients undergoing cholecystectomy surgeries with or without concomitant antithrombotic therapy. RESULTS: Nine studies were included. Meta-analysis revealed that the use of antithrombotic medications had no statistically significant effect on intra-operative blood loss in patients undergoing cholecystectomy (MD: 82.31 95% CI: -283.38, 448 I(2)=98% p=0.66). However, incidence of blood transfusion (OR: 5.65 95% CI: 1.10, 28.86 I(2)=83% p=0.04) and bleeding complications (OR: 8.02 95% CI: 1.71, 37.58 I(2) = 71% p=0.008) were significantly increased in patients under antithrombotic therapy. Pooled analysis indicated that cholecystectomy patients under antithrombotic are at an increased risk of conversion to open surgery (OR: 2.02 95% CI: 1.21, 3.36 I(2)=0% p=0.007). Meta-analysis revealed significantly shorter LOS in patients under antithrombotic (MD: -5.01 95% CI: -8.29, -1.73 I(2)=97% p=0.03). CONCLUSION: Current evidence from a limited number of studies indicates that the use of antithrombotic may be associated with an increased risk of bleeding-related complications in patients undergoing cholecystectomies. Antithrombotic use may also increase the risk of conversion to open surgery in patients undergoing laparoscopic cholecystectomies.