Antiplatelet Therapy in Patients With Coronary Stent Undergoing Urologic Surgery: Is It Still No Man's Land?

Naspro, Richard; Rossini, Roberta; Musumeci, Giuseppe; Gadda, Franco; Pozzo, L.F. Da

doi:10.1016/j.eururo.2013.01.026

Cited by 12 publications

(8 citation statements)

References 24 publications

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Section: Discussionmentioning

confidence: 99%

“…However, concerns regarding the feasibility and safety of continued aspirin use before and during major operations, such as open or minimally invasive radical prostatectomies, have sparked recent controversies and debate. 9,10 In parallel with this is the fact that the number of patients with cerebrovascular or coronary heart disease is growing worldwide. Consequently, the use of coronary stents and antiplatelet drugs is increasing.…”

Section: Discussionmentioning

confidence: 99%

“…Present-day literature still has controversies regarding the continuation of aspirin during a variety of urologic procedures, such as transurethral resection of the prostate or bladder tumor, and endoscopic and percutaneous stone procedures. 9,10 The robotic platform, specifically in its use for prostate cancer treatment, has significantly reduced surgical morbidity by up to 30%, perioperative bleeding risk, and decreased the blood transfusion rate by approximately 10-fold during robot-assisted radical prostatectomy (RARP). 11 Based on this rationale, some institutions have changed their practice and are having patients continue aspirin use perioperatively in those undergoing RARP who have significant cardiovascular disease and risks.…”

Section: Introductionmentioning

confidence: 99%

“…Present-day literature still has controversies regarding the continuation of aspirin during a variety of urologic procedures, such as transurethral resection of the prostate or bladder tumor, and endoscopic and percutaneous stone procedures. 9,10 The Should aspirin be suspended prior to robot-assisted radical prostatectomy? A systematic review and meta-analysis robotic platform, specifically in its use for prostate cancer treatment, has significantly reduced surgical morbidity by up to 30%, perioperative bleeding risk, and decreased the blood transfusion rate by approximately 10-fold during robot-assisted radical prostatectomy (RARP).…”

Section: Introductionmentioning

confidence: 99%

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Should aspirin be suspended prior to robot-assisted radical prostatectomy? A systematic review and meta-analysis

Carneiro

Doyun

Baccaglini

et al. 2019

Therapeutic Advances in Urology

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Background:Low-dose aspirin use has been correlated with an increased risk of bleeding and overall complications in surgical and invasive diagnostic procedures. In this review, our aim was to analyze the current literature on whether robot-assisted radical prostatectomy (RARP) is feasible and safe in patients taking low-dose aspirin perioperatively.Methods:A systematic review was performed identifying a total of 767 studies, published between January 2000 and September 2017, with five of these studies meeting the inclusion criteria for the meta-analysis, totalizing 1481 patients underwent RARP. Patients were divided into two groups: taking aspirin (group A) and those not taking aspirin (group B) perioperatively.Results:There were no significant differences between groups in the overall [group A 10.7% versus group B 15.7%, risk ratio (RR) 0.83; p = 0.45; I2 = 0%] or major complication rates (group A 1% versus group B 3%, RR 0.98; p = 0.98; I² = 0%), rate of cardiovascular events (group A 1.4% and group B 0.5%, RR 2.06; p = 0.24; I2 = 9%), blood loss (group A 278 ml versus group B 307 ml, SMD −0.12; p = 0.91; I2 = 96%), or hospital length of stay [group A 4 days (3–5) and group B 4 days (3–4), SMD −0.09; p = 0.52; I² = 0%]. There was a slightly higher blood-transfusion rate in group A (2.6%) versus group B (1.6%) (RR, 5.05; p = 0.04; I2 = 0%).Conclusion:Continued aspirin use in the perioperative period does not correlate with an increase in surgical morbidity, blood loss, or hospital length of stay. There was a slightly higher blood-transfusion rate in patients taking low-dose aspirin (group A) perioperatively.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Present-day literature still has controversies regarding the continuation of aspirin during a variety of urologic procedures, such as transurethral resection of the prostate or bladder tumor, and endoscopic and percutaneous stone procedures. 9,10 The Should aspirin be suspended prior to robot-assisted radical prostatectomy? A systematic review and meta-analysis robotic platform, specifically in its use for prostate cancer treatment, has significantly reduced surgical morbidity by up to 30%, perioperative bleeding risk, and decreased the blood transfusion rate by approximately 10-fold during robot-assisted radical prostatectomy (RARP).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Should aspirin be suspended prior to robot-assisted radical prostatectomy? A systematic review and meta-analysis

Carneiro

Doyun

Baccaglini

et al. 2019

Therapeutic Advances in Urology

View full text Add to dashboard Cite

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“…Although the review also considered the management of AP/AC drugs during various urologic procedures, including shock wave lithotripsy, ureteroscopy with laser lithotripsy, percutaneous nephrolithotomy, laser prostatectomy, transurethral resection of the prostate, ultrasound-guided prostate biopsy, radical prostatectomy, and surgical renal procedures, it did not discuss the appropriate management of patients undergoing TURBT. A review of AP therapy in patients with coronary stents who underwent urologic surgery [ 8 ] included TURBT as a high risk procedure for bleeding. This review recommended that APs should be discontinued in patients at low thromboembolic risk undergoing TURBT, while elective surgery should be postponed if possible in patients at intermediate or high risk.…”

Section: Discussionmentioning

confidence: 99%

Risks and complications of transurethral resection of bladder tumors in patients receiving antiplatelet and/or anticoagulant therapy: a retrospective cohort study

et al. 2017

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BackgroundInformation on the safety of transurethral resection of bladder tumors (TURBT) in patients receiving anti-thromboembolic drugs is currently lacking. This study aimed to evaluate the clinical safety of TURBT in patients receiving anti-thromboembolic agents compared with patients not taking these agents and patients who interrupted their use perioperatively.MethodsWe retrospectively analyzed data for patients who underwent TURBT at Jichi Medical University Saitama Medical Center from September 2013 to August 2016.Patients who underwent surgery while receiving antiplatelet and/or anticoagulant drugs were allocated to the continuation group, those who interrupted these drugs comprised the interruption group, and those who did not use these agents were designated as the control group. We compared the patient characteristics, hemoglobin levels, and complications among the three groups.ResultsA total of 174 patients were analyzed including 19, 18, and 137 in the continuation, interruption, and control groups, respectively. There were no significant differences in patient and tumor characteristics, apart from age, among the three groups. Decreases in hemoglobin levels were similar in the continuation, interruption, and control groups (−0.50 g/dl, −0.40 g/dl, and −0.50 g/dl, respectively).Significantly more patients in the continuation group experienced clot retention compared with the control group (21% vs 5%, p = 0.03). Large tumor size tended to be a risk factor for clot retention in the continuation group (p = 0.07). No patient in the continuation or interruption group required blood transfusion, compared with two patients (1%) in the control group. No patients in any of the groups experienced cardiovascular events during their hospital stay or required rehospitalization for hematuria after discharge.ConclusionsTURBT can be performed safely in patients who continue to take antiplatelet and/or anticoagulant agents, without increasing the risks of severe hemorrhage and blood transfusion. However, the risk of postoperative clot retention may be increased in these patients.

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Clopidogrel Therapy in Patients with Cardiovascular Disease Undergoing Transurethral Resection of the Prostate: A Step Towards Individualization

et al. 2017

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Antiplatelet Therapy in Patients With Coronary Stent Undergoing Urologic Surgery: Is It Still No Man's Land?

Cited by 12 publications

References 24 publications

Should aspirin be suspended prior to robot-assisted radical prostatectomy? A systematic review and meta-analysis

Should aspirin be suspended prior to robot-assisted radical prostatectomy? A systematic review and meta-analysis

Risks and complications of transurethral resection of bladder tumors in patients receiving antiplatelet and/or anticoagulant therapy: a retrospective cohort study

Clopidogrel Therapy in Patients with Cardiovascular Disease Undergoing Transurethral Resection of the Prostate: A Step Towards Individualization

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