Advertisement
You are prohibited from using or uploading content you accessed through this website into external applications, bots, software, or websites, including those using artificial intelligence technologies and infrastructure, including deep learning, machine learning and large language models and generative AI.

Purpose:

A clinical dilemma surrounds the use of aspirin therapy during laparoscopic partial nephrectomy. Despite reduced cardiac morbidity with perioperative aspirin use, fear of bleeding related complications often prompts discontinuation of therapy before surgery. We evaluate perioperative outcomes among patients continuing aspirin and those in whom treatment is stopped preoperatively.

Materials and Methods:

A total of 430 consecutive cases of laparoscopic partial nephrectomy performed between January 2012 and October 2014 were reviewed. Patients on chronic aspirin therapy were stratified into on aspirin and off aspirin groups based on perioperative status of aspirin use. Primary end points evaluated included estimated intraoperative blood loss and incidence of bleeding related complications, major postoperative complications, and thromboembolic events. Secondary outcomes included operative time, transfusion rate, length of hospital stay, rehospitalization rate and surgical margin status.

Results:

Among 101 (23.4%) patients on chronic aspirin therapy, antiplatelet treatment was continued in 17 (16.8%). Bleeding developed in 1 patient in the on aspirin group postoperatively and required angioembolization. Conversely 1 myocardial infarction was observed in the off aspirin cohort. There was no significant difference in the incidence of major postoperative complications, intraoperative blood loss, transfusion rate, length of hospital stay and rehospitalization rate. Operative time was increased with continued aspirin use (181 vs 136 minutes, p=0.01).

Conclusions:

Laparoscopic partial nephrectomy is safe and effective in patients on chronic antiplatelet therapy who require perioperative aspirin for cardioprotection. Larger, prospective studies are necessary to discern the true cardiovascular benefit derived from continued aspirin therapy as well as better characterize associated bleeding risk.

References

  • 1 : A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50,279 patients at risk for coronary artery disease. Eur Heart J2006; 27: 2667. Google Scholar
  • 2 : Effect of discontinuing aspirin therapy on the risk of brain ischemic stroke. Arch Neurol2005; 62: 1217. Google Scholar
  • 3 : Perioperative antiplatelet therapy. Am Fam Physician2010; 82: 1484. Google Scholar
  • 4 : 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation2014; 130: 2215. Google Scholar
  • 5 : AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: endorsed by the National Heart, Lung, and Blood Institute. Circulation2006; 113: 2363. Google Scholar
  • 6 : Anticoagulation and antiplatelet therapy in urological practice: ICUD/AUA review paper. J Urol2014; 192: 1026. LinkGoogle Scholar
  • 7 : Guideline for management of the clinical T1 renal mass. Ann Surg2009; 182: 1271. Google Scholar
  • 8 : The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol2009; 182: 844. LinkGoogle Scholar
  • 9 : Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery. Eur Urol2009; 56: 786. Google Scholar
  • 10 : Delayed haemorrhage after laparoscopic partial nephrectomy: frequency and angiographic findings. BJU Int2011; 107: 1460. Google Scholar
  • 11 : Laparoscopic radical versus partial nephrectomy: assessment of complications. J Urol2003; 170: 408. LinkGoogle Scholar
  • 12 : The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg2009; 250: 187. Google Scholar
  • 13 : The effect of low-dose acetylsalicylic acid on bleeding after transurethral prostatectomy–a prospective, randomized, double-blind, placebo-controlled study. Scand J Urol Nephrol2000; 34: 194. Google Scholar
  • 14 : Transrectal ultrasound-guided biopsy of the prostate: aspirin increases the incidence of minor bleeding complications. Clin Radiol2008; 63: 557. Google Scholar
  • 15 : Continuing or discontinuing low-dose aspirin before transrectal prostate biopsy: results of a prospective randomized trial. Urology2007; 70: 501. Google Scholar
  • 16 : Percutaneous nephrolithotomy during uninterrupted aspirin therapy in high-cardiovascular risk patients: preliminary report. Urology2014; 84: 1034. Google Scholar
  • 17 : Continuous low-dose aspirin therapy in robotic-assisted laparoscopic radical prostatectomy does not increase risk of surgical hemorrhage. J Laparoendosc Adv Surg Tech Part A2013; 23: 500. Google Scholar
  • 18 : Open and robot-assisted radical retropubic prostatectomy in men receiving ongoing low-dose aspirin medication: revisiting an old paradigm?. BJU Int2014; 114: 396. Google Scholar
  • 19 : Is it necessary to stop antiplatelet agents before a native renal biopsy?. Nephrol Dial Transplant2008; 23: 3566. Google Scholar
  • 20 : Preoperative aspirin is safe in patients undergoing urologic robot-assisted surgery. J Endourol2012; 26: 852. Google Scholar
  • 21 : Coronary stent management in elective genitourinary surgery. BJU Int2012; 110: 480. Google Scholar
  • 22 : Antiplatelet therapy in patients with coronary stent undergoing urologic surgery: is it still no man’s land?. Eur Urol2013; 64: 101. Google Scholar
  • 23 : Outcomes of partial nephrectomy in patients on chronic oral anticoagulant therapy. J Urol2008; 180: 2370. LinkGoogle Scholar
  • 24 : Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol2007; 178: 41. LinkGoogle Scholar
  • 25 : “Trifecta” in partial nephrectomy. J Urol2013; 189: 36. LinkGoogle Scholar
  • 26 : Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association. Circulation2001; 104: 1694. Google Scholar
Advertisement