Evaluating the safety profile of anti-platelet therapy in patients undergoing elective inguinal hernia repair: a systematic review and meta-analysis

医学 荟萃分析 置信区间 优势比 腹股沟疝 随机对照试验 外科 输血 内科学
作者
Matthew G. Davey,William Joyce
出处
期刊:Irish Journal of Medical Science [Springer Science+Business Media]
卷期号:193 (2): 897-902
标识
DOI:10.1007/s11845-023-03480-w
摘要

Abstract Introduction There remains no consensus surrounding the safety of prescribing anti-platelet therapies (APT) prior to elective inguinal hernia repair (IHR). Aims To perform a systematic review and meta-analysis evaluating the safety profile of APT use in patients indicated to undergo elective IHR. Methods A systematic review was performed in accordance with PRISMA guidelines. Meta-analyses were performed using the Mantel–Haenszel method using the Review Manager version 5.4 software. Results Five studies including outcomes in 344 patients were included. Of these, 65.4% had APT discontinued (225/344), and 34.6% had APT continued (119/344). The majority of included patients were male (94.1%, 288/344). When continuing or discontinuing APT, there was no significant difference in overall haemorrhage rates (odds ratio (OR): 1.86, 95% confidence interval (CI): 0.29–11.78, P = 0.130) and in sensitivity analysis using only RCT data (OR: 0.63, 95% CI: 0.03–12.41, P = 0.760). Furthermore, there was no significant difference in reoperation rates (OR: 6.27, 95% CI: 0.72–54.60, P = 0.590); however, a significant difference was observed for readmission rates (OR: 5.67, 95% CI: 1.33–24.12, P = 0.020) when APT was continued or stopped pre-operatively. There was no significant difference in the estimated blood loss, intra-operative time, transfusion of blood products, rates of complications, cerebrovascular accidents, myocardial infarctions, or mortality observed. Conclusion This study illustrates the safety of continuing APT pre-operatively in patients undergoing elective IHR, with similar rates of haemorrhage, reoperation, and readmission observed. Clinical trials with larger patient recruitment will be required to fully establish the safety profile of prescribing APT in the pre-operative setting prior to elective IHR.
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