Effect of antithrombotic therapy on postoperative outcome of 538 consecutive emergency laparoscopic cholecystectomies for acute cholecystitis: two Italian center’s study


The risk of developing hemorrhagic complications during or after emergency cholecystectomy (EC) for acute cholecystitis (AC) in patients with antithrombotic therapy (ATT) remains uncertain. In this double-center study, we evaluated post-operative outcomes in patients with ATT undergoing EC. We retrospectively evaluated 538 patients who underwent laparoscopic EC for AC between May 2015 and December 2019 at two referral centers. 89 of them (17%) were on ATT. We defined postoperative complication rates, including bleeding, as our primary outcome. Mortality was higher in the ATT group. Morbidity was higher in the ATT group as well; however, the difference was not statistically significant. 12 patients (2%) experienced intraoperative blood loss over 500 ml and ten (2%) had postoperative bleeding complications. Two patients (< 1%) experienced both intraoperative and postoperative bleeding. On multivariate analysis, ATT was not significantly associated with worse postoperative outcomes. Antithrombotic therapy is not an independently associated factor of severe postoperative complications (including bleeding) or mortality. However, these patients still represent a challenging group and must be carefully managed to avoid postoperative bleeding complications.

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We wish to thank Ms. Claudia CIRILLO (M.A. in English and Consultant for Thomas Jefferson University-Philadelphia-PA-USA) for her English language editing of our text.

Author information




SV, AL, MC, GP, RC, VDA, and VT conceptualized and designed the study, acquired, and analyzed data, interpreted the study results, drafted the manuscript, and critically revised the manuscript for important intellectual content. EG, APP, RB, DDN, and AU acquired and analyzed data, and interpreted the study results.

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Correspondence to Augusto Lauro.

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All authors declared that they have no potential conflict of interest.

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All authors declared that they no receive financial support and sponsorship.

Ethical approval

All procedures performed in the participants of our study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study received approval from the hospital’s institutional review board (156/2018/Oss/AOUBo, 18/04/18).

Informed consent

Our study received approval from the hospital’s institutional review board (156/2018/Oss/AOUBo, 18/04/18). Informed consent was obtained from every patient included in this cohort of study.

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Vaccari, S., Lauro, A., Cervellera, M. et al. Effect of antithrombotic therapy on postoperative outcome of 538 consecutive emergency laparoscopic cholecystectomies for acute cholecystitis: two Italian center’s study. Updates Surg (2021). https://doi.org/10.1007/s13304-021-00994-9

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  • Acute cholecystitis
  • Anticoagulation therapy
  • Antiplatelet therapy
  • Antithrombotic therapy
  • Bleeding complication
  • Emergency cholecystectomy
  • Laparoscopy