Abstract
The interrelationship between diabetes mellitus and cardiovascular disease is well-documented,
and, secondary to the latter, is the use of antiplatelet therapy. Although diabetes
and the associated vascular manifestations are driving forces behind lower extremity
amputations, few data are available on the risks of perioperative antiplatelet therapy
with foot and ankle amputations. The goal of the present study was to address the
surgical effect of continuing or discontinuing antiplatelet therapy before foot and/or
ankle amputation. The following data were retrospectively collected: blood loss, pre-
and postoperative hematocrit and hemoglobin, operative time, amputation type, age,
diabetic status, antiplatelet treatment, and number of transfusions during the perioperative
period. Perioperative antiplatelet therapy was defined as exposure to aspirin or clopidogrel
within 3 days before surgery. To compare the outcomes between groups, the following
factors were analyzed using bivariate analyses and then multivariate regression models:
(1) the need for transfusions, (2) high blood loss (>20 mL), (3) volume of blood loss,
and (4) operative time. The noninferiority of continued antiplatelet use was assessed
in terms of operative time and blood loss, using a noninferiority margin of 10 minutes
or 10 mL, respectively. Antiplatelet therapy was not a statistically significant risk
factor for any of the studied outcomes on multivariate analysis. Equivalence testing
revealed that continuing antiplatelet therapy is not inferior to discontinuing perioperative
therapy in terms of blood loss and operative time. Multivariate analysis of the data
suggested that antiplatelet therapy has no statistically significant impact on blood
loss, transfusion rate, or operative time.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: September 07, 2016
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
Copyright
© 2016 by the American College of Foot and Ankle Surgeons. All rights reserved.
