Effect of continued perioperative antithrombotic therapy on bleeding outcomes following laparoscopic nephrectomy and nephroureterectomy.
antiplatelets
nephrectomy
nephroureterectomy
Journal
Asian journal of endoscopic surgery
ISSN: 1758-5910
Titre abrégé: Asian J Endosc Surg
Pays: Japan
ID NLM: 101506753
Informations de publication
Date de publication:
Jan 2023
Jan 2023
Historique:
revised:
01
06
2022
received:
08
04
2022
accepted:
15
06
2022
pubmed:
6
7
2022
medline:
5
1
2023
entrez:
5
7
2022
Statut:
ppublish
Résumé
In this study, we aimed to assess the impact of perioperative continuation of antithrombotic therapy on bleeding and complications in patients undergoing laparoscopic radical nephrectomy (LRN) and nephroureterectomy (LNU). This was a retrospective observational study. Patients who underwent LRN and LNU between January 2017 and July 2019 at our institution were recruited. All patients taking antithrombotic agents continued taking them during the perioperative phase (AA group). Surgical outcomes of patients in the AA group were compared with those of patients who were not taking antithrombotic agents (NA group). The primary outcome was the rate of bleeding complications. Secondary outcomes included intraoperative estimated blood loss, transfusion rate, and complications for up to 90 days. A total of 100 patients were included in the analysis, with 36 and 64 patients assigned to the AA and NA groups, respectively. Patients in the AA group were found to have more severe comorbidities than those in the NA group, with a Charlson Comorbidity Index ≥5, totaling 14 (39%) and 12 (19%), respectively (P = .03). According to surgical outcomes, none of the patients in the AA group required secondary procedures for bleeding complications. Moreover, there were no significant differences between the groups in intraoperative blood loss, hemoglobin deficit, rate of perioperative transfusion, readmission rate, or high-grade complications. These results indicate that perioperative use of antithrombotic agents does not increase the risk of bleeding and can be considered safe during LRN and LNU.
Substances chimiques
Fibrinolytic Agents
0
Types de publication
Observational Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
7-13Informations de copyright
© 2022 Asia Endosurgery Task Force and Japan Society of Endoscopic Surgery and John Wiley & Sons Australia, Ltd.
Références
Pathak RA, Hemal AK. Techniques and outcomes of robot-assisted nephro-ureterectomy for upper tract urothelial carcinoma. Eur Urol Focus. 2018;4:657-661.
Xia L, Wang X, Xu T, Guzzo TJ. Systematic review and meta-analysis of comparative studies reporting perioperative outcomes of robot-assisted partial nephrectomy versus open partial nephrectomy. J Endourol. 2017;31:893-909.
Culkin DJ, Exaire EJ, Green D, et al. Anticoagulation and antiplatelet therapy in urological practice: ICUD/AUA review paper. J Urol. 2014;192:1026-1034.
Ellis G, John Camm A, Datta SN. Novel anticoagulants and antiplatelet agents; a guide for the urologist. BJU Int. 2015;116:687-696.
Browne E, Haroon U, Davis NF, Forde JC. Perioperative management of new oral anticoagulants in urological surgery. Curr Urol. 2018;11:169-174.
Leavitt DA, Keheila M, Siev M, et al. Outcomes of laparoscopic partial nephrectomy in patients continuing aspirin therapy. J Urol. 2016;195:859-864.
Packiam VT, Nottingham CU, Cohen AJ, Pearce SM, Shalhav AL, Eggener SE. The impact of perioperative aspirin on bleeding complications following robotic partial nephrectomy. J Endourol. 2016;30:997-1003.
Ito T, Derweesh IH, Ginzburg S, et al. Perioperative outcomes following partial nephrectomy performed on patients remaining on antiplatelet therapy. J Urol. 2017;197:31-36.
Pradere B, Peyronnet B, Seisen T, et al. Impact of anticoagulant and antiplatelet drugs on perioperative outcomes of robotic-assisted partial nephrectomy. Urology. 2017;99:118-122.
Matsuoka T, Inoue K, Mizuno K, et al. Heparin as bridging anticoagulant and antiplatelet therapy during the perioperative period. Hinyokika Kiyo. 2012;58:223-226.
Sfakianos JP, Hakimi AA, Kim PH, et al. Outcomes in patients undergoing nephrectomy for renal cancer on chronic anticoagulation therapy. Eur J Surg Oncol. 2014;40:1700-1705.
Varkarakis IM, Rais-Bahrami S, Allaf ME, et al. Laparoscopic renal-adrenal surgery in patients on oral anticoagulant therapy. J Urol. 2005;174:1020-1023.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205-213.
Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187-196.
Tamhankar AS, Patil SR, Ahluwalia P, Gautum G. Does continuation of low-dose aspirin during robot-assisted radical prostatectomy compromise surgical outcomes? J Endourol. 2018;32:852-858.
Kefer JC, Desai MM, Fergany A, Novick AC, Gill IS. Outcomes of partial nephrectomy in patients on chronic oral anticoagulant therapy. J Urol. 2008;180:2370-2374.