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Outcomes of Laparoscopic Partial Nephrectomy in Patients Continuing Aspirin Therapy
Thu - September 8, 2016 8:21 am  |  Article Hits:2551  |  A+ | a-
Patients with coronary artery disease are at 3 times higher risk for thromboembolic complications if off Aspirin1. Distinct guidelines for use of antiplatelet agents don’t exist for all major urological procedures. Significant blood loss during laparoscopic procedures requiring transfusion or conversion to open occur at 4% to 6%2. Continuation of antiplatelet therapy may disrupt homeostasis and compromise oncological outcomes. The purpose of this study was to determine outcomes associated with continued aspirin use during laparoscopic partial nephrectomy (LPN). Authors performed a retrospective evaluation of 434 patients who underwent LPN from Jan 2012- Oct 2014. The patient’s age, gender, MBI, comorbidities, use and duration of aspirin and other antiplatelet or anticoagulant therapies, indication for antiplatelet therapy, tumor characteristics, ASA score, EBL, volume of IV fluids administered, operative time, and warm ischemia time were recorded. Chronic aspirin users were split into two groups: those continuing and non-continuing aspirin use perioperatively. All patients underwent transperitoneal LPN. Of 434 patients 101 were on chronic antiplatelet therapy. 17 remained on Aspirin at this time of the procedure and 84 stopped aspirin use perioperatively. Those on Aspirin had higher ASA scores. The operative time was longer for those on aspirin (181 minutes vs. 136 minutes) (p<0.01). No difference in ischemia time of estimated blood loss between the two groups. There was a change between preoperative and postoperative nadir hematocrit and transfusion rate. Length of stay was the same between the two groups. No intraoperative complications and no significant difference in complications. One complication in the group that stayed on aspirin. The patient had an endophytic 5cm mass involving the collecting system (RENAL score-8 PADUA-10). Had a bleed post operatively on day 1 requiring transfusion and renal angioembolism and an ICU stay. The same patient 2 weeks later had bleeding from a duodenal ulcer. One experienced a myocardial infarction. No perioperative thromboembolic events. The hospital readmission rate was similar in both groups. All patients had negative margins and there were no urinary leaks. Evidence supports antiplatelet therapy perioperatively especially in high-risk cardiovascular patients3. Transfusion rate for those on aspirin was 12%. The bleeding duodenal ulcer 2 weeks after may have had underlying bleeding diathesis. 5.5% incidence of major clinical complication. Since only one patient it is considered a low absolute risk. Increased procedure length probably due to more time spent on hemostasis and careful dissection. Also insufflation and inspection in the OR. This study is limited because it is retrospective, and complex tumors were most likely managed after cessation of aspirin use. They don’t have a full range in the group that stayed on aspirin. Patients in the on group are not standardized for cardiovascular risk level. There is also a small sample size. There is a need for larger prospective studies.
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