Should Aspirin Be Suspended Prior to Robot-assisted Radical Prostatectomy? - Beyond the Abstract

We performed a systematic review and meta-analysis of the contemporary cohorts comparing patients submitted to robot-assisted radical prostatectomy (RARP) taking aspirin perioperatively to those not taking aspirin, focusing on morbidity (overall and major complications, cardiac events, blood loss and transfusion, and hospital length of stay), because we understand that at present-day there are no comprehensive studies approaching these safety outcomes.

In addition, this work was very exciting as it corroborated with our thinking that the robotic platform, specifically in its use for the treatment of prostate cancer, significantly reduced surgical morbidity. Therefore, this would allow us to change our practice and maintain aspirin use in the perioperative period in those patients submitted to RARP who have significant cardiovascular disease and cardiovascular risk.

We extracted data independently from each of the five reports and our methodology was based on ‘the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement’ (PRISMA).

This current meta-analysis suggests that continued aspirin use in the perioperative period does not correlate with an increase in surgical morbidity, blood loss, or hospital length of stay. Despite, there was a slightly higher blood transfusion rate in patients taking low dose aspirin perioperatively, RARP in these patients taking aspirin appears to be feasible and safe, with no significant increased morbidity.

Written by:
Willy Baccaglini, MD, Research Fellow, University of Southern California, Institute of Urology, Los Angeles, CA
Arie Carneiro1, Jonathan Doyun Cha1  Fatima Z. HusainMarcelo Langer WroclawskiIgor Nunes-Silva3, Rafael Sanchez-Salas4, Alexandre Ingels4, Paulo Priante Kayano1, Oliver Rojas Claros1, Natasha Kouvaleski Saviano Moran1, René Sotelo2, Gustavo Caserta Lemos1
1. Israelita Albert Einstein Hospital, São Paulo, Brazil Discipline of Urology, ABC Medical School, São Paulo, Brazil
2. Institute of Urology, University of Southern California, Los Angeles, California, USA
3. Arnaldo Vieira de Carvalho Cancer Institute – IAVC, São Paulo, Brazil
4. Department of Urology, Institut Mutualiste Montsouris, Paris, France

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