PMID- 37808421
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20231031
IS  - 2589-8450 (Electronic)
IS  - 2589-8450 (Linking)
VI  - 16
DP  - 2023 Dec
TI  - Management of acute cholecystitis in patients on anti-thrombotic therapy: A 
      single center experience.
PG  - 94-97
LID - 10.1016/j.sopen.2023.09.022 [doi]
AB  - BACKGROUND: Acute cholecystitis in patients on anti-thrombotic therapy (ATT) 
      presents a clinical dilemma at the intersection between conflicting guidelines, 
      specifically between timing of early operative management (OM) versus 
      time-to-reversal of certain ATT agents. With growing recognition that 
      nonoperative management (NOM) is associated with considerable morbidity, and 
      evidence in the literature that early OM in patients on ATT is safe, we reviewed 
      our own practice to examine how we addressed these conflicting guidelines. 
      MATERIALS AND METHODS: We performed a retrospective review of patients with acute 
      cholecystitis between December 2017 and March 2022. Patients were classified as 
      ATT or non-ATT; ATT patients were subdivided into anticoagulation (AC) and 
      antiplatelet (AP) groups. Rates of OM were compared. RESULTS: 502 patients with 
      acute cholecystitis were identified, 464 non-ATT and 38 ATT. 30 ATT patients were 
      on AC, 7 on AP, and 1 on both. Non-ATT patients were significantly more likely to 
      receive OM at index presentation compared to those on ATT: 89.9 % vs 63.2 % 
      (p < 0.05). Subgroup analysis of the ATT group showed AP patients were 
      significantly less likely to receive OM compared to those on AC, 12.5 % vs 77 % 
      (p < 0.05). CONCLUSIONS: At our institution, patients on ATT were significantly 
      less likely to undergo OM for acute cholecystitis compared with non-ATT patients. 
      Those on AC received OM significantly more than patients on AP. Further study is 
      needed to better define the management of this growing population so that acute 
      cholecystitis guidelines might address this issue in the future.
CI  - (c) 2023 The Authors.
FAU - Feuerwerker, Solomon
AU  - Feuerwerker S
AD  - Department of Surgery, University of Vermont Medical Center, 111 Colchester Ave, 
      Burlington, VT 05401, USA.
FAU - Kambli, Ruja
AU  - Kambli R
AD  - Larner College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, 
      VT 05405, USA.
FAU - Grinberg, Diana
AU  - Grinberg D
AD  - Department of Surgery, University of Vermont Medical Center, 111 Colchester Ave, 
      Burlington, VT 05401, USA.
FAU - Malhotra, Ajai
AU  - Malhotra A
AD  - Department of Surgery, University of Vermont Medical Center, 111 Colchester Ave, 
      Burlington, VT 05401, USA.
FAU - An, Gary
AU  - An G
AD  - Department of Surgery, University of Vermont Medical Center, 111 Colchester Ave, 
      Burlington, VT 05401, USA.
LA  - eng
PT  - Journal Article
DEP - 20231001
PL  - United States
TA  - Surg Open Sci
JT  - Surgery open science
JID - 101768812
PMC - PMC10551647
OTO - NOTNLM
OT  - Acute cholecystitis
OT  - Anticoagulant
OT  - Antiplatelet
OT  - Antithrombotic therapy
OT  - Laparoscopic cholecystectomy
OT  - Percutaneous cholecystostomy
COIS- The authors declare that they have no known competing financial interests or 
      personal relationships that could have appeared to influence the work reported in 
      this paper.
EDAT- 2023/10/09 06:42
MHDA- 2023/10/09 06:43
PMCR- 2023/10/01
CRDT- 2023/10/09 05:37
PHST- 2023/08/02 00:00 [received]
PHST- 2023/09/28 00:00 [accepted]
PHST- 2023/10/09 06:43 [medline]
PHST- 2023/10/09 06:42 [pubmed]
PHST- 2023/10/09 05:37 [entrez]
PHST- 2023/10/01 00:00 [pmc-release]
AID - S2589-8450(23)00084-2 [pii]
AID - 10.1016/j.sopen.2023.09.022 [doi]
PST - epublish
SO  - Surg Open Sci. 2023 Oct 1;16:94-97. doi: 10.1016/j.sopen.2023.09.022. eCollection 
      2023 Dec.