Antiplatelets Can Continue Prior to Ventral Hernia Repair

Reed BL, Warren JA, Love MW, et al. Effect of Antiplatelet and Anticoagulant Therapy on Bleeding Complications following Ventral Hernia Repair: An ACHQC analysis. Am J Surg. 236, 115856 (2024).

The use of oral anticoagulants, especially direct oral anticoagulants, increased by 54% in the US between 2012 and 2017. Perioperative management of patients who are taking oral anticoagulants or antiplatelet drugs requires achieving a balance between protection from thromboembolism and minimizing risk of bleeding.

This study used data from a national database (n = 37,973) to compare the rates of bleeding complications in patients undergoing ventral hernia repair who were taking either oral anticoagulants or antiplatelet agents.

Oral anticoagulants were used in 5.4% of patients and antiplatelet agents in 11.5%. Postoperative bleeding requiring transfusion, reoperation, or readmission was significantly increased in patients taking oral anticoagulants, but risk of bleeding was not increased in patients taking antiplatelet agents. The increased bleeding risk was present even though anticoagulant drug dosing was interrupted and “bridging” with low molecular weight heparin was used.

The authors concluded that patients should be informed of bleeding risk and that antiplatelet agents do not need to be discontinued prior to ventral hernia repair.