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Background <p>Antiplatelet (AP) therapy is increasingly prescribed for secondary and primary cardiovascular prevention. Liver resection (LR) is inherently associated with moderate-to-high risk of bleeding, while AP therapy discontinuation may increase the incidence of thrombotic events. Evidence regarding the safety of continuing AP therapy during robotic LR is limited. The aim of this study was to assess hemorrhagic and ischemic events in patients undergoing elective robotic LR and their association with AP continuation.</p> Methods <p>Patients who underwent robotic LR at our institution between 2013 and 2025 were retrospectively evaluated. Patients receiving AP therapy were compared with controls, both before and after 1:1 propensity score matching (PSM). Primary endpoints included in-hospital mortality, estimated blood loss (EBL) &gt; 500 mL, post-hepatectomy hemorrhage (PHH), postoperative bleeding events, and ischemic events. Associations between AP continuation and intra- and postoperative outcomes were assessed through univariate analysis.</p> Results <p>Before matching, 62 patients were included in the AP group and 594 in the control group. Age, diabetes, cardiovascular comorbidities, Charlson Comorbidity Index, and MELD score were significantly higher in the AP cohort. After PSM, 46 patients were included in each group. No significant differences were observed between AP and control groups in EBL &gt; 500 mL (6.1% vs. 6.5%, <i>p</i> = 0.784; OR 1.07, 95% CI 0.37–3.11, <i>p</i> = 0.903), PHH (2.2% vs. 3.2%, <i>p</i> = 0.644; OR 1.49, 95% CI 0.33–6.76, <i>p</i> = 0.622), postoperative bleedings (3.4% vs. 6.5%, <i>p</i> = 0.272; OR 1.98, 95% CI 0.65–5.99, <i>p</i> = 0.259), in-hospital mortality (0.8% vs. 3.2%, <i>p</i> = 0.135; OR 3.93, 95% CI 0.75–20.68, <i>p</i> = 0.149), or ischemic events (1.5% vs. 3.2%, <i>p</i> = 0.279; OR 2.17, 95% CI 0.46–10.26, <i>p</i> = 0.368).</p> Conclusions <p>Continuation of antiplatelet therapy was not associated with intra- and postoperative bleedings or ischemic events in our cohort. These findings suggest that robotic LR is safe in patients maintained on AP agent and support its perioperative continuation.</p>

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Safety of robotic liver resection under antiplatelet therapy: a propensity score-matching study

  • 期刊论文

  • 发表日期：

    2026年7月31日

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  • Giuseppe Esposito,
  • Marcella Manicardi,
  • Sharona Ross,
  • Garnet Vanterpool Jr.,
  • Owen Haripersad,
  • Kristina Milivojev Covilo,
  • Mira Khaldoun Eid,
  • Anna Axentiev,
  • Iswanto Sucandy

摘要

Background

Antiplatelet (AP) therapy is increasingly prescribed for secondary and primary cardiovascular prevention. Liver resection (LR) is inherently associated with moderate-to-high risk of bleeding, while AP therapy discontinuation may increase the incidence of thrombotic events. Evidence regarding the safety of continuing AP therapy during robotic LR is limited. The aim of this study was to assess hemorrhagic and ischemic events in patients undergoing elective robotic LR and their association with AP continuation.

Methods

Patients who underwent robotic LR at our institution between 2013 and 2025 were retrospectively evaluated. Patients receiving AP therapy were compared with controls, both before and after 1:1 propensity score matching (PSM). Primary endpoints included in-hospital mortality, estimated blood loss (EBL) > 500 mL, post-hepatectomy hemorrhage (PHH), postoperative bleeding events, and ischemic events. Associations between AP continuation and intra- and postoperative outcomes were assessed through univariate analysis.

Results

Before matching, 62 patients were included in the AP group and 594 in the control group. Age, diabetes, cardiovascular comorbidities, Charlson Comorbidity Index, and MELD score were significantly higher in the AP cohort. After PSM, 46 patients were included in each group. No significant differences were observed between AP and control groups in EBL > 500 mL (6.1% vs. 6.5%, p = 0.784; OR 1.07, 95% CI 0.37–3.11, p = 0.903), PHH (2.2% vs. 3.2%, p = 0.644; OR 1.49, 95% CI 0.33–6.76, p = 0.622), postoperative bleedings (3.4% vs. 6.5%, p = 0.272; OR 1.98, 95% CI 0.65–5.99, p = 0.259), in-hospital mortality (0.8% vs. 3.2%, p = 0.135; OR 3.93, 95% CI 0.75–20.68, p = 0.149), or ischemic events (1.5% vs. 3.2%, p = 0.279; OR 2.17, 95% CI 0.46–10.26, p = 0.368).

Conclusions

Continuation of antiplatelet therapy was not associated with intra- and postoperative bleedings or ischemic events in our cohort. These findings suggest that robotic LR is safe in patients maintained on AP agent and support its perioperative continuation.