NEW ORLEANS, LA USA (UroToday.com) - Percutaneous interventions for coronary artery disease are one of the most common hospital procedures being performed today. About 75% of coronary artery stents being placed are drug-eluting, necessitating long term anti-platelet (AP) therapy. Thus, encountering patients who must remain on AP therapy during surgery is inevitable. To date the safety of performing partial nephrectomy while a patient remains on AP therapy is underreported. In this study our group aimed to evaluate the perioperative outcomes of patients remaining on AP therapy at the time of partial nephrectomy.
In total 754 patients were included in the study, 26 who remained on AP therapy during partial nephrectomy, 156 who were on chronic AP therapy preoperatively but stopped it at least 5 days prior to surgery and 572 not on AP therapy. Of those remaining on AP therapy, 77% were taking aspirin 81mg, and 19% were taking aspirin 325mg. Complications within 30 days were examined and our group defined bleeding complications as the transfusion of more than 2 units of packed red blood cells during initial hospitalization or any readmission or procedure performed primary due to hemorrhage.
It was found that patients remaining on aspirin at the time of partial nephrectomy were older and more frequently male when compared to patients who were able to hold their chronic AP therapy and patients not on chronic AP therapy. They also had more comorbid conditions, reflected by a higher mean ASA classification score. No difference in nephrometry score was seen between the groups, and approximately 65% of patients in each group underwent minimally invasive surgery.
With regards to operative outcomes our group found that perioperative aspirin use did not result in any differences in operative time, estimated blood loss, or ischemia time. An increase in overall complications and transfusion rate, postoperatively, was seen with aspirin use however this was not statistically significant. Patients on aspirin, however, experienced a significantly higher rate of bleeding complications compared to the other groups. It was confirmed on multivariable analysis that perioperative aspirin use was an independent predictor of bleeding complications, resulting in an over five-fold increased risk.
It was concluded that remaining on aspirin at the time of partial nephrectomy is associated with an increased risk of complications related to hemorrhage. It will be important to validate these findings in a larger cohort. When encountering patients who must remain on AP therapy at the time of partial nephrectomy, appropriate counseling is important to manage patients’ expectations regarding perioperative outcomes.
Presented by Timothy Ito, MD at the American Urological Association (AUA) Annual Meeting - May 15 - 19, 2015 - New Orleans, LA USA
Fox Chase Cancer Center, Philadelphia, PA USA