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Ito T , Derweesh IH , Ginzburg S , Abbosh PH , Raheem OA , Mirheydar H , Hamilton Z , Chen DY , Smaldone MC , Greenberg RE , Viterbo R , Kutikov A , Uzzo RG
Perioperative Outcomes Following Partial Nephrectomy Performed on Patients Remaining on Antiplatelet Therapy
J Urol. 2017 Jan;197(1) :31-36
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Abstract
PURPOSE: We evaluated the risk of bleeding complications in patients undergoing partial nephrectomy in whom perioperative antiplatelet therapy was continued, as antiplatelet therapy is increasingly used and hemorrhage is a significant concern in partial nephrectomy. MATERIALS AND METHODS: In this 2-center retrospective analysis 1,097 patients underwent partial nephrectomy between 2000 and 2014. The cohort was split into 3 groups of perioperative continuation of antiplatelet therapy (group 1-67), antiplatelet therapy stopped preoperatively (group 2-254) and no chronic antiplatelet therapy (group 3-776). Bleeding complications were defined as any transfusion, or any hospital readmission or secondary procedure performed for hemorrhage. Multivariable analysis was performed to elucidate independent risk factors for bleeding complications. RESULTS: Patients in group 1 were older (median age 66 years vs 64 and 57 years in groups 2/3, p <0.0001), and had greater comorbidity (median ASA classification 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 transfusions (16.4% vs 5.9% and 5.4%, p=0.002). Multivariable analysis revealed continued antiplatelet therapy was an independent predictor of bleeding complications (OR 2.19, 95% CI 1.06-4.51, p=0.03). These findings appear attributable to intraoperative clopidogrel use. On multivariable analysis the use of aspirin alone was not associated with bleeding complications (OR 1.64, 95% CI 0.72-3.75, p=0.24). CONCLUSIONS: The risk of bleeding complications due to antiplatelet therapy use at partial nephrectomy may be due to clopidogrel. The need to continue perioperative aspirin alone does not appear to be a contraindication to the safe performance of partial nephrectomy.
Notes
1527-3792 Ito, Timothy Derweesh, Ithaar H Ginzburg, Serge Abbosh, Philip H Raheem, Omer A Mirheydar, Hossein Hamilton, Zachary Chen, David Y T Smaldone, Marc C Greenberg, Richard E Viterbo, Rosalia Kutikov, Alexander Uzzo, Robert G Journal Article Multicenter Study United States J Urol. 2017 Jan;197(1):31-36. doi: 10.1016/j.juro.2016.07.001. Epub 2016 Jul 11.