Preoperative Aspirin Is Safe in Patients Undergoing Urologic Robot-Assisted Surgery

Parikh, Ankur; Toepfer, Nicholas J.; Baylor, Kelly; Henry, Yvette; Berger, Peter B.; Rukstalis, Daniel B.

doi:10.1089/end.2011.0491

Cited by 22 publications

(23 citation statements)

References 7 publications

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“… and Parikh et al. , comprising 236 and 95 patients, have examined the influence of low‐dose aspirin intake on median blood loss and transfusion rates in patients undergoing RARP. Both sets of authors observed no significant differences in peri‐operative median blood loss and transfusion rates between patients in the RARP cohort with and without ongoing aspirin intake; however, the first study included only six patients in the aspirin group.…”

Section: Discussionmentioning

confidence: 99%

Open and robot‐assisted radical retropubic prostatectomy in men receiving ongoing low‐dose aspirin medication: revisiting an old paradigm?

et al. 2014

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Objective• To assess blood loss, transfusion rates and 90-day complication rates in patients receiving ongoing 100 mg/day aspirin medication and undergoing open radical prostatectomy (RP) or robot-assisted RP (RARP). Between February 2010 and August 2011, 2061 open RPs and 400 RARPs were performed. All patients received low-molecular-weight heparin for thrombembolism prophylaxis. Aspirin intake during surgery was recorded in 137 patients (5.5%). Patients and Methods •• Descriptive statistics and multivariable analyses after propensity-score matching for balancing potential differences in patients with and without aspirin medication were used to assess the risk of blood loss above the median in patients undergoing open RP or RARP. Results• The median blood loss in the open RP cohort with and without aspirin medication was 750 and 700 mL, respectively, and in the RARP cohort it was 200 and 150 mL, respectively. Within the same cohorts, transfusions were administered in 21 and 8% and 0 and 1% of patients, respectively.• The 90-day complication rates in patients with ongoing aspirin medication were 5.8, 4.4, 7.3 and 0% for Clavien grades I, II, III and IV complications, respectively. • In multivariable analyses and after propensity-score matching, prostate volume (odds ratio 1.03; 95% CI 1.02-1.04; P < 0.01) but not ongoing aspirin medication achieved independent predictor status for the risk of blood loss above the median. Conclusions• Major surgery such as open RP and RARP can be safely performed in patients with ongoing aspirin medication without greater blood loss. • Higher 90-day complication rates were not detected in such patients.• Differences in transfusion rates between the groups receiving and not receiving ongoing aspirin medication may be explained by a higher proportion of patients with coronary artery disease in the group receiving ongoing aspirin mediciation. This comorbidity may result in a higher peri-operative threshold for allogenic blood transfusion.

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Section: Discussionmentioning

confidence: 99%

Open and robot‐assisted radical retropubic prostatectomy in men receiving ongoing low‐dose aspirin medication: revisiting an old paradigm?

et al. 2014

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“…None of the patients analyzed had a transfusion. [6] Our patients stopped their aspirin use 7 days prior to surgery and thus is a different group of patients that the those in the studies described above, we also did not find differences in EBL or rates of grade 3–5 complications between our aspirin, no therapy and ACT patient cohorts. While there was a statistical significant difference in LOS amongst the cohorts it was not clinically relevant.…”

Section: Discussionmentioning

confidence: 65%

“…Several studies have looked at the effects of continued aspirin during robotic prostatectomy with one study also analyzing a small cohort of nephrectomy patients. [5, 6] Parikh et al analyzed 26 patients undergoing robotic nephrectomy, 14 on aspirin compared to 12 not on asprin, and found no differences in blood loss, operative time and LOS. None of the patients analyzed had a transfusion.…”

Section: Discussionmentioning

confidence: 99%

Outcomes in patients undergoing nephrectomy for renal cancer on chronic anticoagulation therapy

Sfakianos

Hakimi

Kim

et al. 2014

European Journal of Surgical Oncology (EJSO)

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Aims To report our experience on surgical resection of renal tumors for patients with a history of chronic anticoagulation (ACT) or aspirin use. Methods We performed a retrospective analysis of 2,473 patients who underwent surgery for renal tumors between 2005 and 2012. Prior to surgery, 172 were on chronic ACT and 695 on aspirin. Multivariable linear and logistic regression models were used to compare transfusion and overall complication rates between patients undergoing renal surgery who were on therapy to patients who were on aspirin and to patients with no therapy. Results Compared to no therapy and aspirin patients those on ACT were older (57.3 (IQR 48.4–66.10) vs 63.9, (IQR 57.3–71.5) vs 68.4, (IQR 60.4–73.5); p<0.001), with a higher percentage having an ASA score of 3 or 4 (42.4 vs 57.9 vs 82.6%; p<0.001), respectively. ACT patients had a higher 30-day transfusion rate, 22.7% vs 7.6% vs 6.9%, and 90-day complication rate, 17.4% vs 7.2% vs 7.3%, both p < 0.001. The median length of stay differed statistically between groups (p<0.001), with a modest longer stay in the anticoagulation group (OR 1.11 SE 0.26; p<0.001). Transfusion and complication rates for patients on therapy undergoing minimally invasive surgery vs open surgery were not statistically different. Conclusions Patients on chronic ACT had higher transfusion and overall complication rates compared to patients on no treatment or on chronic aspirin. These findings did not correlate to clinical differences in length of stay or grade 3–5 complications.

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“…However, the OAT group in this study consisted of only 6 patients, limiting its statistical power and the conclusion. Subsequently, Parikh et al 26 and Binhas et al 27 presented their first data with larger cohorts regarding the implementation of laparoscopic radical prostatectomy/RARP under continuous OAT. They reported no significant differences in the transfusion rates and postoperative hemorrhagic complications.…”

Section: Mortezavi Et Almentioning

confidence: 99%

“…However, both studies reported significant differences in the preoperative parameters due to the lack of randomization or matching. Furthermore, no data on the oncological and early surgical outcome 26 or on the oncological outcome only 27 were presented. To achieve comparable groups, we performed a matching of patients according to tumor stage, nerve-sparing, and lymphadenectomy.…”

Section: Mortezavi Et Almentioning

confidence: 99%

Continuous Low-Dose Aspirin Therapy in Robotic-Assisted Laparoscopic Radical Prostatectomy Does Not Increase Risk of Surgical Hemorrhage

Mortezavi

Hermanns

Hefermehl

et al. 2013

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Background: Withdrawal of oral antiplatelet therapy (OAT) is a major risk factor for stent thrombosis, myocardial infarction, and cerebral strokes. In order to minimize the risk for thrombotic complications, since 2007 robotic-assisted laparoscopic radical prostatectomy (RARP) has taken place under continuous OAT with aspirin at our institution. In this retrospective study we analyzed the risk for perioperative bleeding and surgical outcome after RARP with OAT. Patients and Methods: All patients who underwent RARP with aspirin OAT at our institution since 2007 were included in this analysis. The OAT group was compared with a group that underwent RARP without OAT, which contained twice the number of patients. Matching of the two groups was performed with regard to the tumor stage and whether a lymph node dissection or nerve-sparing was performed. Results: Thirty-eight patients were assigned to the OAT group and 76 to the control group. A difference in the decrease of postoperative hemoglobin concentration was not detectable between the two groups (mean drop of 2.9±1.4 g/dL and 2.9±1.1 g/dL, respectively; P=.93). RARP was completed in all OAT patients without conversion to open surgery. Two of the 38 patients (5.3%) in the OAT group and none in the control group required blood transfusions (P=.11). Equivalent rates of positive surgical margins for pT2 tumors were detected (16% OAT versus 14% control group; P=1.0). No adverse cardiovascular events occurred in either group during the hospitalization. Conclusions: Continued perioperative OAT with aspirin in RARP is safe, feasible, and not associated with increased blood loss. Background: Withdrawal of oral antiplatelet therapy (OAT) is a major risk factor for stent thrombosis, myocardial infarction, and cerebral strokes. In order to minimize the risk for thrombotic complications, since 2007 robotic-assisted laparoscopic radical prostatectomy (RARP) has taken place under continuous OAT with aspirin at our institution. In this retrospective study we analyzed the risk for perioperative bleeding and surgical outcome after RARP with OAT. Patients and Methods: All patients who underwent RARP with aspirin OAT at our institution since 2007 were included in this analysis. The OAT group was compared with a group that underwent RARP without OAT, which contained twice the number of patients. Matching of the two groups was performed with regard to the tumor stage and whether a lymph node dissection or nerve-sparing was performed. Results: Thirty-eight patients were assigned to the OAT group and 76 to the control group. A difference in the decrease of postoperative hemoglobin concentration was not detectable between the two groups (mean drop of 2.9 -1.4 g/dL and 2.9 -1.1 g/dL, respectively; P = .93). RARP was completed in all OAT patients without conversion to open surgery. Two of the 38 patients (5.3%) in the OAT group and none in the control group required blood transfusions (P = .11). Equivalent rates of positive surgical margins for pT2 tumors were detected ...

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Preoperative Aspirin Is Safe in Patients Undergoing Urologic Robot-Assisted Surgery

Abstract: The administration of aspirin to patients undergoing robot-assisted radical prostatectomy and nephrectomy appears to be safe. The risk of cardiovascular complications resulting from stopping aspirin may exceed the risk of perioperative bleeding and associated complications.

Cited by 22 publications

References 7 publications

Open and robot‐assisted radical retropubic prostatectomy in men receiving ongoing low‐dose aspirin medication: revisiting an old paradigm?

Open and robot‐assisted radical retropubic prostatectomy in men receiving ongoing low‐dose aspirin medication: revisiting an old paradigm?

Outcomes in patients undergoing nephrectomy for renal cancer on chronic anticoagulation therapy

Continuous Low-Dose Aspirin Therapy in Robotic-Assisted Laparoscopic Radical Prostatectomy Does Not Increase Risk of Surgical Hemorrhage

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