We evaluated the risk of bleeding complications in patients undergoing partial nephrectomy (PN) in whom perioperative anti-platelet (AP) therapy was continued, as AP therapy is increasingly utilized and hemorrhage is a significant concern in PN.
Two-center retrospective analysis of 1097 patients undergoing PN between 2000-2014. The cohort was split into three groups: Perioperative continuation of AP therapy (Group-1, n=67), AP therapy stopped preoperatively (Group-2, n=254), and no chronic AP therapy (Group-3, n=776). Bleeding complications were defined as any transfusion, or any readmission or secondary procedure performed for hemorrhage. Multivariable analysis (MVA) was performed to elucidate independent risk factors for bleeding complications.
Group-1 patients were older (median age 66 vs. 64 and 57 years in Groups-2/-3, p<0.0001), and had greater co-morbidity (median ASA score 3 vs. 2 and 2, p<0.0001). Group-1 had a higher rate of bleeding complications (20.9% vs. 7.1% and 6.4%, p<0.0001) and transfusion rates (16.4% vs. 5.9% and 5.4%, p=0.002). MVA revealed continued AP therapy was an independent predictor for bleeding complications (OR 2.19, 95% CI 1.06-4.51, p=0.03). These findings appear attributable to intraoperative clopidogrel use. On MVA, use of aspirin alone was not associated with bleeding complications (OR 1.64, 95% CI 0.72-3.75, p=0.24).
Risk of bleeding complications due to AP therapy use at time of PN may be due to clopidogrel. Need to continue perioperative aspirin alone does not appear to be a contraindication to safe performance of PN.
The Journal of urology. 2016 Jul 11 [Epub ahead of print]
Timothy Ito, Ithaar H Derweesh, Serge Ginzburg, Philip H Abbosh, Omer A Raheem, Hossein Mirheydar, Zachary Hamilton, David Y T Chen, Marc C Smaldone, Richard E Greenberg, Rosalia Viterbo, Alexander Kutikov, Robert G Uzzo
Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA., Department of Urology, University of California San Diego School of Medicine, San Diego, CA., Department of Urology, Einstein Healthcare Network, Philadelphia, PA., Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA., Department of Urology, University of California San Diego School of Medicine, San Diego, CA., Department of Urology, University of California San Diego School of Medicine, San Diego, CA., Department of Urology, University of California San Diego School of Medicine, San Diego, CA., Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA., Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA., Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA., Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA., Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA., Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA. Electronic address: .