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

Carneiro, Ariê; Doyun, Jonathan; Baccaglini, Willy; Husain, Fatima Z; Wroclawski, Marcelo Langer; Nunes‐Silva, Igor; Sánchez-Salas, Rafael; Ingels, Alexandre; Kayano, Paulo Priante; Claros, Oliver Rojas; Moran, Natasha Kouvaleski Saviano; Sotelo, René; Lemos, Gustavo Caserta

doi:10.1177/1756287218816595

Cited by 17 publications

(10 citation statements)

References 46 publications

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“…Several retrospective studies and one systematic review studied the safety of APs in RARP. According to these studies, continuation of aspirin is not correlated with an increased risk of perioperative surgical morbidity, blood loss, or hospitalization length, with the exception of a slightly higher transfusion rate in these patients (2.6% vs. 1.6%) [7][8][9][10][11][12]. In the present study, there were no cases of transfusion in either the AP or the control group, and the estimated blood loss was lower in both of the AP and the control group compared with that reported previously (Table 4).…”

Section: Discussionmentioning

confidence: 94%

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Risks and complications of robot-assisted radical prostatectomy (RARP) in patients receiving antiplatelet and/or anticoagulant therapy: a retrospective cohort study in a single institute

et al. 2020

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The objective of the study was to evaluate the risk of bleeding complications in patients undergoing robot-assisted radical prostatectomy (RARP) while taking antiplatelet (AP) and/or anticoagulant (AC) agents. We analyzed the data of 334 patients undergoing RARP from May 2015 to May 2019. Patients were categorized into AP, AC, and control groups; the bleeding complications were compared among them. The end points were the estimated blood loss, decrease in hemoglobin level, and bleeding complications. The patient characteristics did not differ significantly among groups, with the exception of ASA scores, which were significantly higher in the AP and AC groups vs. the control group. The estimated blood loss and hemoglobin decrease were not significantly different between the AP and AC groups and the control group. The frequency of bleeding complications did not differ significantly between the AP and the control groups, but was significantly higher in the AC vs. the control group (4.3% in the AP and 23.5% in the AC group vs. 3.7% in the control group; P = 0.63 and P < 0.01, respectively). There was no significant difference in bleeding complications between the AP continuation (continuation of a single AP) and the AP interruption group or between the heparin bridging and the AC interruption group. All bleeding complications observed in the AC group occurred after resuming AC therapy. RARP can be performed safely with continuation of a single AP, and in patients taking ACs by interrupting these agents or via heparin bridging, without increasing intraoperative bleeding, whereas postoperative bleeding complications may increase after resuming ACs.

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Section: Discussionmentioning

confidence: 94%

“…Therefore, the management of APs and/or ACs needs to be customized for RARP. However, few studies have evaluated the safety of RARP in patients receiving APs and/or ACs [7][8][9][10][11][12]. Currently, additional information on this subject is needed.…”

Section: Introductionmentioning

confidence: 99%

Risks and complications of robot-assisted radical prostatectomy (RARP) in patients receiving antiplatelet and/or anticoagulant therapy: a retrospective cohort study in a single institute

et al. 2020

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“…Carneiro et al concluded that continued aspirin use in the peri-operative period does not correlate with an increase in surgical morbidity, blood loss, or hospital length of stay [26].…”

Section: Discussionmentioning

confidence: 99%

Safety of not withholding clopidogrel therapy during the immediate several days pre- and post-trans-urethral resection of prostate (TURP): a retrospective cohort study

Abdulhamid

Khalaf²

2022

Int Urol Nephrol

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Background and aim Benign prostatic hypertrophy or hyperplasia (BPH) is a frequent urological complain particularly in old-aged individuals. Those patients usually have other risk factors (such as ischemic cardiovascular diseases) for which they might be treated with anti-thrombotic agents chronically. These medicines may induce blood thinning and raise the incidence of hemorrhage. Thus, if those patients needed operative treatment for BPH, they may be at high risk of hemorrhage or its related adverse effects with the usage of anti-thrombotic drugs during the peri-operative time. On the other hand, dis-continuation of these agents can lead to ischemic events in susceptible individuals. Therefore, this research aims to assess the safety of the continuation of using anti-thrombotic agents throughout the perioperative duration in patients with prostate surgery in form of Transurethral Resection of Prostate (TURP) only for Benign Prostatic Hypertrophy (BPH). Methods Patients' notes were reviewed retrospectively. The entire participants were categorized into two categories. First category was on clopidogrel therapy (CTC) for prolong time and the usage of these agents was carried on throughout the peri-operative period. The second category was not on clopidogrel therapy at all (NCTC). Both of these categories had Transurethral Resection of Prostate (TURP) for Benign Prostatic Hypertrophy (BPH). A comparison had been conducted between the two categories with regards to: (i) the amount of blood lost intra-operatively (ii) the duration of operation (iii) hematocrit concentration per-operatively (iv) transfused packed red blood cells (PRBC) if needed (v) clearance of hematuria postoperatively (vi) secondary hemorrhage and clot retention after discharge. Pearson Chi-square test, Independent sample t test and test for numeric variables were used as appropriate. ResultsThe study identified 329 patients. One hundred and sixty five participants in the CTC (clopidogrel therapy category) and 164 in the NCTC (non-clopidogrel therapy category). It had been revealed that there was no statistically significant difference between the CTC and NCTC regarding: (i) the amount of blood lost intra-operatively (ii) the duration of operation (iii) hematocrit concentration per-operatively (iv) transfused packed red blood cells (packed RBC) if needed (v) clearance of hematuria postoperatively (vi) secondary hemorrhage and clot retention after discharge (P > 0.65). ConclusionThe continuation of usage of anti-thrombotic therapy (clopidogrel) during peri-operative period in patients with TURP for BPH is a safe practice. It is not associated with high probability of hemorrhage or PRBC transfusion or other adverse effects.

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“…29 Recent studies in lung, orthopedic and abdominal surgery suggest low or negligible bleeding risk with perioperative continuation of aspirin. [32][33][34][35][36][37][38][39] Recommendations in the facial plastics and dermatologic literature also suggest that continuation of antithrombotic medications is associated with low rates of severe hemorrhagic complications. 8,30,[40][41][42] However, it is important to note that results from other specialties may not be transferable due to the unique risk of vision loss with oculoplastic surgeries.…”

Section: Understanding Surgical Bleeding Riskmentioning

confidence: 99%

Perioperative Considerations for Antithrombotic Therapy in Oculofacial Surgery: A Review of Current Evidence and Practice Guidelines

Kim

Pfeiffer

Chang

et al. 2022

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Recent survey studies have demonstrated wide variability in practice patterns regarding the management of antithrombotic medications in oculofacial plastic surgery. Current evidence and consensus guidelines are reviewed to guide perioperative management of antithrombotic medications.Methods: Comprehensive literature review of PubMed database on perioperative use of antithrombotic medication.Results/Conclusions: Perioperative antithrombotic management is largely guided by retrospective studies, consensus recommendations, and trials in other surgical fields due to the limited number of studies in oculoplastic surgery. This review summarizes evidence-based recommendations from related medical specialties and provides context for surgeons to tailor antithrombotic medication management based on patient's individual risk. The decision to continue or cease antithrombotic medications prior to surgery requires a careful understanding of risk: risk of intraoperative or postoperative bleeding versus risk of a perioperative thromboembolic event. Cessation and resumption of antithrombotic medications after surgery should always be individualized based on the patient's thrombotic risk, surgical and postoperative risk of bleeding, and the particular drugs involved, in conjunction with the prescribing doctors. In general, we recommend that high thromboembolic risk patients undergoing high bleeding risk procedures (orbital or lacrimal surgery) may stop antiplatelet agents, direct oral anticoagulants, and warfarin including bridging warfarin with low-molecular weight heparin. Low-risk patients, regardless of type of procedure performed, may stop all agents. Decision on perioperative management of antithrombotic medications should be made in conjunction with patient's internist, cardiologist, hematologist, or other involved physicians which may limit the role of guidelines depending on patient risk and should be used on a case-by-case basis. Further studies are needed to provide oculofacial-specific evidence-based guidelines.

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

Cited by 17 publications

References 46 publications

Risks and complications of robot-assisted radical prostatectomy (RARP) in patients receiving antiplatelet and/or anticoagulant therapy: a retrospective cohort study in a single institute

Risks and complications of robot-assisted radical prostatectomy (RARP) in patients receiving antiplatelet and/or anticoagulant therapy: a retrospective cohort study in a single institute

Safety of not withholding clopidogrel therapy during the immediate several days pre- and post-trans-urethral resection of prostate (TURP): a retrospective cohort study

Perioperative Considerations for Antithrombotic Therapy in Oculofacial Surgery: A Review of Current Evidence and Practice Guidelines

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