The Risk Of Aspirin Induced Postoperative Hemorrhage:A Systematic Review And Meta-analysis

Background: Several guidelines recommend aspirin administration does not result in bleeding post high-risk endoscopic procedures.However,some Asian physicians have found opposite results.Objective: A systematic review and meta-analysis were performed to determine whether the risk of postoperative bleeding result from aspirin administration differs in the East and West.Methods: Pub Med,EMBASE database,Sino Med and and Wanfang database were systematically reviewed to identify studies to include in this analysis.Relevant references were also checked for additional data.Only trials met our criteria were included.Results: In this study,seventeen trials were included.The results showed an overall positive association between aspirin and postoperative bleeding(OR 2.18;95%CI1.66-2.86,P<0.001).For Eastern population,the results showed that aspirin was associated with a markedly higher risk of bleeding(OR 2.43;95%CI 1.89-3.11,P <0.001),however,the result from the West was insignificant(OR 1.78;95%CI 0.95-3.35,P=0.07).For patients underwent ESD,when compared with those who did not use aspirin,both patients discontinued aspirin and maintained aspirin therapy had a significantly higher risk of bleeding after surgery(maintained aspirin vs non user:OR 2.88;95%CI 1.94-4.28,P<0.001;discontinued aspirin vs non user: OR 2.44;95%CI 1.37-4.35,P=0.003).Besides,those who continued to receive aspirin had a much higher bleeding risk than patients who interrupted it for more than 7 days(OR 3.63;95%CI 1.47-8.95,P=0.005),but the result was insignificant when compared with those withdrew aspirin for less than 7 days(OR 0.85;95% CI 0.42-1.72,P=0.66).Aspirin had a slight effect on bleeding after polypectomy(OR 1.61;95% CI 1.04-2.48,P=0.032),but did not significantly increase the risk of bleeding after endoscopic sphincterotomy(OR 1.40;95%CI 0.52-3.79,P=0.508).Conclusion: In high-risk endoscopic operations,aspirin may increase risk of postoperative hemorrhage.Furthermore,Eastern population are more likely to experience bleeding than Westerners following aspirin administration.Aspirin can significantly increase the risk of bleeding after ESD.Stopping aspirin for more than 7 days may effectively help control the occurrence of bleeding.Aspirin can cause a slight increase in the risk of bleeding after polypectomy and has no significant effect on bleeding after EST.However,due to limited studies were included,and significant heterogeneity existed,the results need to be treated with caution.