Antithrombotic Prescriptions for Many General Surgery Patients Significantly Increases the Likelihood of Post-Operative Bleeding Complications.

Background: The investigators hypothesized that despite cessation recommendations for peri-operative antithrombotic management in the elective setting, the use of these drugs is likely associated with increased odds for bleeding complications. Methods: Humana (R) insurance claims (22 million covered lives) from 2007 through 2017 were analyzed. Only patients undergoing elective general surgery procedures were included. Patient Safety Indicator 09 (PSI-09) coding for post-operative hemorrhage and hematoma were analyzed. Results: Despite the existence of pen-operative management guidelines, patients prescribed antithrombotic agents were 2.3 times more likely to develop post-operative bleeding complications (OR: 2.3436, 95% CI: 2.2155-2.4792, P <0.0001). Nearly all antithrombotics prescribed in the pre-operative period led to a two-fold increased likelihood of post-operative bleeding-the odds ratios of enoxaparin and rivaroxaban approached seven. Conclusion: The data should remind surgeons to closely monitor the peri-operative management and post-operative course of patients pre-operatively prescribed antithrombotics-especially enoxaparin and rivaroxaban given the high risk of postoperative bleeding complications. (C) 2019 Elsevier Inc. All rights reserved.