Impact of Anticoagulant and Antiplatelet Drugs on Perioperative Outcomes of Robotic-assisted Partial Nephrectomy

Abstract

International audienceObjective: To evaluate the impact of anticoagulant (AC) or antiplatelet (AP) therapy on the morbidity of robot-assisted partial nephrectomy (RAPN).Materials and Methods From 2011 to 2015, we retrospectively analyzed a prospectively maintained institutional review board–approved database of RAPN from 2 academic departments of urology. We evaluated the occurrence of overall complications and hemorrhagic complications (pseudoaneurysm, arteriovenous fistula, hematoma, transfusion). Patients with therapeutic AC or AP, stopped or not before surgery, were compared with patients without therapeutic AC or AP. A logistic regression model was used to identify predictors of complications.Results Out of 533 patients who underwent RAPN, 70 had AC or AP (50% aspirin, 25% clopidogrel, 28% AC, 8% direct oral AC). Clopidogrel, AC, and direct oral AC were always stopped preoperatively. Aspirin was continued in 25% of the cases. In univariate analysis, overall complications (39.2% vs 17.4%; P = .001) and hemorrhagic complications (32.7% vs 9.6%; P <.001) were higher in patients on AC or AP. Hospital stay was longer in the group with therapeutic AC or AP treatment (5.1 vs 3.9 days; P <.001). In multivariate analysis, predictors of complications were intake of therapeutic AC (odds ratio [OR] = 4.3, IC95% [1.2-15.9], P = .03) and tumor size (OR = 1.8, IC95% [1.3-7.2], P = .03). Patients on aspirin tended to have more complications (OR = 2.4; IC95% [0.4-9.3]; P = .15).Conclusion AP and therapeutic AC increase the morbidity of RAPN. These treatments should be taken into account in treatment decision-making algorithm of small renal masses

Is postoperative Doppler ultrasonography useful for the early detection of asymptomatic pseudoaneurysm and prevention of haemorrhagic complications after partial nephrectomy?

“…Patients on regular AP or AC treatment were found by Pradere et al. to have a higher risk of haemorrhagic complications, regardless of whether the treatment was withheld or continued. In the present study, the rate of patients on AC or AP treatment before the surgery (15.7%) was similar to that observed in the study by Pradere et al.…”

“…Alternatively, a specific screening, focused on patients ‘at risk’, could be relevant, looking specifically at patients with higher risk of postoperative bleeding (who are on AC or CP treatment), indeed, Pradere et al. reported a PA incidence of 10% for these patients, which is significantly higher than the incidence in the global population. In addition, patients living in isolated rural areas with limited access to interventional radiology may also benefit from a systematic early postoperative screening for PA with DUS before being allowed to go back home.…”

Continuous Perioperative use of Aspirin as Single Therapy during Percutaneous Nephrolithotomy

“…Continuing aspirin in the perioperative period resulted in a 7.2% absolute risk reduction (95% CI, 1.3-13%), without any significant difference in bleeding complications. 14 Moreover, several studies looking at renal procedures performed while on antiplatelet therapy have shown no increased risk of bleeding complications, including native 15 and transplant 16 kidney biopsies and laparoscopic 17 and robot-assisted [18][19][20][21] partial nephrectomy. Two series published by Leavitt et al 10,11 looked at PCNL performed while on aspirin.…”

Laparoscopic and Robotic-Assisted Partial Nephrectomy: An Overview of Hot Issues

“…With increasing incidence of cardiovascular and cerebrovascular diseases, tumor patients often need to take long-term antiplatelet drugs because of stent indentation. For renal cancer patients who have been taking antiplate-let drugs for a long time, there is no consensus on whether to stop antiplatelet drugs before MIPN (Table 4) [43][44][45][46]. When to stop and how long still need further exploration.…”