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Antithrombotics and intraoperative transfusion 3
Table 1 Preoperative medications reviewed during thecomprehensive geriatric Gly Pro pNA assessment.
Therapeutic Category Medications
Potentially inappropriate medication Delirium risk
Anticholinergics
First-generation Chlorpheniramine, antihistamines Hydroxyzine Antispasmodics Chlordiazepoxide, Scopolamine Antipsychotics Quetiapine Benzodiazepines
Short- and Alprazolam, Triazolam intermediate -acting
Long-acting Clonazepam, Diazepam Chlorpromazine
Corticosteroids Prednisolone H2-receptor Cimetidine, Ranitidine antagonists
Sedative hypnotics Zolpidem Fall risk
Anticonvulsants Carbamazepine, Valproate Antipsychotics Chlorpromazine, Quetiapine Benzodiazepines
Short- and Alprazolam, Triazolam intermediate-acting
Long-acting Diazepam Nonbenzodiazepine Zolpidem benzodiazepine
receptor agonist
hypnotics
Tricyclic Amitriptyline, Imipramine antidepressants
Selective serotonin Duloxetine, Paroxetine reuptake inhibitors
Opioids Fentanyl, Morphine Preoperative discontinuation-requiring medications Bleeding risk
Anticoagulant agents
Short-acting Dabigatran, Dalteparin,
Rivaroxaban Long-acting Mesoglycan, Sulodexide,
Warfarin Antiplatelet agents
Short-acting Beraprost, Cilostazol,
Indobufen, Sarpogrelate Long-acting Aspirin, Clopidogrel, Triflusal NSAID
Short-acting Aceclofenac, Dexibuprofen,
Ibuprofen, Loxoprofen,
Mefenamic acid, Talniflumate Long-acting Celecoxib, Meloxicam,
Naproxen Peripheral vasodilator Ibudilast, Kallidinogenase,
Limaprost, Nafronyl oxalate,
Nicergoline Streptokinase/streptodornase Others
Herbal medications Angelica extract, Artemisia
asiatica extract, Avocado-soya
titrated extract, Cimicifugae
Table 1 (continued )
Therapeutic Category Medications
rhizoma extract, Clematidis
Radix/Trichosanthes root/
Prunella spike extract, Coptis
rhizome extract, Ginkgo biloba
leaf extract, Hedera helicis
folia extract, Hypericum
extract, Milk-thistle extract,
Motilitone, Pelargonium
sidoides extract, Petasites
hybridus folium extract,
Phellinus linteus extract,
Vaccinium myrtillus extract,
Vitis vinifera extract, Zea mays
L. titrated extract
Hormone-related Anastrozole, Letrozole,
agents Raloxifene, Tibolone
Metformin
PIMs were evaluated based on the 2015 Beers criteria.19 Among the PIMs, those associated with a high risk of delirium or a high risk of falls were included in the analysis. Levosulpiride (a prokinetic agent available in Korea) was also included; although it is not listed in the Beers criteria, it is known to frequently cause drug-induced movement disorders20 and safer alternatives are available (Table 1).21
The high delirium-risk medications, which may induce adverse events such as delirium, confusion, or hallucina-tion, included anticholinergics, antipsychotics, benzodiaz-epines, chlorpromazine, corticosteroids, H2-receptor antagonists, and sedative hypnotics (Table 1).19 Anticon-
vulsants, antipsychotics, benzodiazepines, non-benzodiazepines (benzodiazepine receptor agonist hypnotics), tricyclic antidepressants, selective serotonin reuptake inhibitors, and opioids were classified as high fall-risk medications (Table 1).19
The number of medications was calculated based on the number of active ingredients. Multi-component digestives, antacids, multivitamins, or herbal extracts were considered a single ingredient because they possess a single efficacy. Topical drugs and eye drops were not included because they are uncommonly associated with systemic adverse events. Polypharmacy and excessive polypharmacy was defined as regularly taking five or more medications and ten or more medications, respectively.22e24 Post-operative delirium was diagnosed by psychiatric consultation using DSM-V criteria.25
2.3. Outcome measures
The primary outcome was intraoperative transfusion requirement.
2.4. Statistical analyses
The chi-square test was used to compare categorical vari-ables. Multivariate logistic regression analysis was used to identify independent risk factors for intraoperative
Please cite this article as: Jeong YM et al., Association between preoperative use of antithrombotic medications and intraoperative transfusion in older patients undergoing cancer surgery, Asian Journal of Surgery, https://doi.org/10.1016/j.asjsur.2019.06.005
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Table 2 Factors associated with intraoperative transfusion.