Safety of Continuing Single-Agent Antithrombotic Therapy During Emergency Cholecystectomy for Acute Cholecystitis: An Overlap-Weighted Propensity Score Analysis With the Hiroshima Surgical Study Group of Clinical Oncology (HiSCO)
In brief
About 1 in 4 had blood loss over 100 mL, with or without antithrombotics
In a seven-hospital study of 1,018 emergency gallbladder surgeries, blood loss over 100 mL occurred in 25.4% of patients who continued one antithrombotic and 27.3% of those taking none. Other bleeding complications and hospital stay also did not differ significantly. The retrospective findings support proceeding when there is no time for the drug to clear, but do not prove equal safety.
- Journal
- Journal of hepato-biliary-pancreatic sciences (Q1)
- Published
- 5 November 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Takeshi Tadokoro, Tomoyuki Abe, Masateru Yamamoto, Yuki Imaoka, Naruhiko Honmyo, Ryosuke Nakano, et al.
- PMID
- 42989468
- DOI
- 10.1002/jhbp.70212
Why clinicians should know about it
- Picked for Surgery (paper of the day, 9 November 2026): Emergency cholecystectomy and perioperative antithrombotic safety
Abstract
BACKGROUND/PURPOSE: Optimal perioperative antithrombotic therapy (ATT) management during emergency cholecystectomy for acute cholecystitis remains controversial. We examined whether continuing single-agent ATT is associated with hemorrhagic risk compared with no ATT. METHODS: This retrospective cohort study included 1018 patients (826 without ATT, 192 continued on single-agent ATT) at seven institutions (2020-2023). Propensity score overlap weighting balanced 12 baseline covariates. The primary outcome was intraoperative blood loss > 100 mL; risk ratios and 95% confidence intervals were estimated via modified Poisson regression, with upper confidence bound compared against a pre-specified risk ratio (1.5). RESULTS: The primary outcome occurred in 27.3% and 25.4% of the non-ATT and continued-ATT groups, respectively (risk ratio: 0.93, 95% confidence interval: 0.69-1.26). The upper bound of the confidence interval was within the pre-specified margin. No significant differences were observed in perioperative bleeding complications or hospital stay. Secondary outcomes, sensitivity analyses, and drug-specific subgroup analyses (including direct oral anticoagulants) yielded consistent results. CONCLUSIONS: Continuing single-agent ATT was comparable to no ATT regarding bleeding during cholecystectomy for acute cholecystitis. These findings suggest that emergency cholecystectomy can be performed without meaningful increases in hemorrhagic risk in patients for whom adequate preoperative ATT washout is not feasible.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.