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Original Investigation
April 2018

Association of Continued Preoperative Aspirin Use and Bleeding Complications in Patients Undergoing Thyroid Surgery

Author Affiliations
  • 1Department of Otolaryngology, Tulane University Medical Center, New Orleans, Louisiana
JAMA Otolaryngol Head Neck Surg. 2018;144(4):335-341. doi:10.1001/jamaoto.2017.3262
Key Points

Question  Do patients receiving aspirin before undergoing thyroid surgery experience increased bleeding complications?

Findings  In this cohort study of 570 adults undergoing thyroid surgery, aspirin use was not associated with an increased risk of blood loss. The association between aspirin use and complications of hematoma or recurrent laryngeal nerve injury was inconclusive because of the small sample size and infrequent events.

Meaning  The results suggest that patients receiving aspirin may expect to undergo thyroid surgery without experiencing clinically meaningful increased bleeding complications, although further investigation is warranted.


Importance  No evidence exists to direct the management of preoperative aspirin (acetylsalicylic acid) use in patients undergoing thyroid surgery. Nevertheless, a considerable number of patients interrupt receiving aspirin therapy during the preoperative period to minimize bleeding complications despite the increased risk of experiencing major adverse cardiac events.

Objective  To determine whether aspirin therapy continued preoperatively increases bleeding complications in patients undergoing thyroid surgery.

Design, Setting, and Participants  Retrospective analysis of a consecutive sample of 570 patients, aged 18 to 100 years, who underwent thyroid surgery for benign and malignant disease from January 1, 2010, to December 31, 2015, by a single surgeon at a tertiary referral hospital center in New Orleans, Louisiana.

Exposures  Patients receiving aspirin therapy and patients not receiving aspirin therapy (aspirin naive) preoperatively.

Main Outcomes and Measures  Comparison of estimated blood loss, substantial blood loss, operative hematoma, nonoperative hematoma, and recurrent laryngeal nerve injury.

Results  Of 570 patients who underwent thyroid surgery, 106 (18.6%) were performed in patients receiving aspirin; of these, 23 (21.7%) were men and 105 (99.1%) were older than 45 years. Those receiving aspirin therapy displayed a 14.4-year difference in age (95% CI, 11.6-17.1). The aspirin group displayed a 20.3% absolute increase (95% CI, 9.3-30.7) in African American patients. Aspirin therapy was not associated with a statistically significant or clinically meaningful increase in intraoperative blood loss (2.5 mL; 95% CI, –0.4 to 5.3). Aspirin therapy was associated with a statistically significant increase in total hematoma formation (3.3%; 95% CI, 0.4-9.0), but the results were inconclusive. Aspirin therapy was not associated with a statistically significant increase in recurrent laryngeal nerve injury (2.6%; 95% CI, –1.1 to 8.6), but the results were inconclusive.

Conclusions and Relevance  These results suggest that aspirin therapy can be maintained prior to thyroid surgery without increased intraoperative bleeding. Further research with a larger sample size and more outcome events are required to make definitive conclusions regarding the association between aspirin use and complications, including hematoma and recurrent laryngeal nerve injury.