Effect of Continued Perioperative Anticoagulant Therapy on Bleeding Outcomes Following Robot-assisted Radical Prostatectomy

Abstract

OBJECTIVE To assess the impact of continued perioperative anticoagulant drug administration on bleeding and complications in patients undergoing robot-assisted radical prostatectomy. METHODS Between January 2014 and January 2020, 620 patients with prostate cancer underwent robotassisted radical prostatectomies and were retrospectively reviewed. Fourteen patients who discontinued antithrombotic therapy were excluded. Among the 606 included patients, 31 continued anticoagulant therapy during the perioperative phase (anticoagulant group). The anticoagulant group outcomes were compared with those of patients who continued clopidogrel and prasugrel (thienopyridine group = 13), aspirin monotherapy (aspirin group = 61), and no chronic antithrombotic agent (control group = 501). The primary outcome was the incidence of bleeding complications requiring transfusion, additional intervention, or readmission. Secondary outcomes were the incidence of thrombotic complications, estimated blood loss, and overall complication rates. RESULTS Among the 31 patients in the anticoagulant group, 20 (65%) used directed oral anticoagulants, 11 (35%) used warfarin, and 5 used combined aspirin. Only 1 (3%) patient in the anticoagulant group required postoperative transfusion, and none required additional interventions or readmission. No significant differences were detected between the anticoagulant and other groups (anticoagulant vs thienopyridine, aspirin, and control groups) regarding bleeding complications (3% vs 8%, P = .

A systematic review and meta-analysis of unplanned hospital visits and re-admissions following radical prostatectomy for prostate cancer

“…Ten of 60 studies tested interventions, [21][22][23]29,32,37,42,45,51,76 such as standardized care pathways, ERAS and fast-track surgery (FTS), and medical/surgical alterations of clinical course (Table 3). Care pathway-like standardized nursing plans and patient education programs did demonstrate only a slight reduction in re-admission and ER visit ( Table 3).…”

“…84 Further tailoring and extension of ERAS/FTS programs, using the synthesis herein, can potentially help for longer-term outcomes, such as UPV. Given that the presence of multiple complications and a short length of stay are associated with postoperative re-admissions, 82 and that home health care increases ER visit rate, 37 there is legible value in interventions that focus on specific groups of re-admission reasons, such as catheter problems, DVT and bleeding such as those by Afzal et al and Kubota et al 22,42 Given that LND during RP can increase the rates of DVT/PE events, 77 particular attention is warranted in this subset of RP patients. Older and more comorbid patients have higher risk of major complications after RP; our study finds that GU complications make up the majority of re-admissions, and thus preoperative assessment strategies are crucial.…”

On the relationship between various anticoagulants and robot-assisted radical prostatectomy: a single-surgeon serial analysis

“…In our series, the transfusion rate was also higher in the all-anticoagulant group 2 (2.4% vs. 1.2%) but without any statistical difference ( p = 0.273). Similarly, Kubota and associates reported no statistical difference in transfusion, interventions, or readmissions in their series of patients who continued their anticoagulants [ 8 ]. Krane and colleagues conducted a study to compare patients receiving VKA with controls in two different regimes [ 4 ].…”

“…Sforza and colleagues found nerve-spared anticoagulated patients to experience more bleeding complications [ 7 ]. Kobuta and associates performed RARP under continued anticoagulation and antiplatelet therapy [ 8 ]. Nonetheless, the evidence on the impact of anticoagulation drugs on the outcomes of RARP is limited and not conclusive.…”

Effects of Thienopyridine Class Antiplatelets on Bleeding Outcomes Following Robot-Assisted Radical Prostatectomy

“…10 Recently, the continued perioperative use of low-dose aspirin therapy during RARP is considered safe and has no correlation with increased blood loss or complications. 7,[11][12][13][14][15] However, the effect of thienopyridine therapies during RARP has not been established, and there is little information available on the perioperative management of this relatively novel class of antiplatelets. The need to limit indications for RARP in patients receiving thienopyridine therapy owing to potentially fatal hemorrhagic complications requires discussion.…”