The effect of antithrombotic drug use on postoperative bleeding following laparoscopic appendectomy

INTRODUCTION: Today, appendectomy is the most frequently performed emergency surgery in general surgery practice. While laparoscopic appendectomy is the gold standard, it is now performed more frequently under the use of antithrombotic drugs due to the increasing global quality of life. This study aimed to determine the incidence of postoperative bleeding and associated risk factors in patients receiving antithrombotic therapy who underwent laparoscopic appendectomy.
METHODS: A total of 847 patients who underwent laparoscopic appendectomy with a diagnosis of acute appendicitis between January 2019 and August 2025 were retrospectively evaluated. Patients were divided into two groups based on antithrombotic drug use: The antithrombotic group (n=42) and the control group (n=805). The primary endpoint was postoperative bleeding, and secondary endpoints included operative time, length of hospital stay, transfusion requirement, and mortality.
RESULTS: The postoperative bleeding rate was 7.1% (n=3) in the antithrombotic group and 1.2% (n=10) in the control group (p=0.019). Multivariable analysis identified antithrombotic drug use (OR: 5.84, 95% CI: 1.52–22.45; p: 0.010), age ≥65 years (OR: 3.12, 95% CI: 1.08–9.02; p: 0.036), and complicated appendicitis (OR: 2.67, 95% CI: 0.94–7.58; p: 0.065) as independent risk factors. Transfusion requirement was significantly higher in the antithrombotic group (4.8% vs. 0.5%, p=0.023).
DISCUSSION AND CONCLUSION: Antithrombotic drug use increases the risk of postoperative bleeding following laparoscopic appendectomy. However, this risk can be maintained at an acceptable level with careful patient selection and appropriate perioperative management. In emergency settings, proceeding with surgery without waiting for discontinuation of antithrombotic therapy may be a reasonable approach to prevent complications of appendicitis.

Keywords: Antithrombotic therapy, aspirin, laparoscopic appendectomy, postoperative bleeding, acute appendicitis

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