Objectives: To evaluate whether continuing the antiplatelet drug acetylsalicylic acid <= 100mg (ASA) during Robotic-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) increases the risk of peri-and postoperative hemorrhagic complications and overall morbidity. Indeed, guidelines recommend interrupting antiplatelet therapy before radical cystectomy; however, RARC with ICUD is associated to reduced estimated blood loss and blood transfusions compared to its open counterpart.Methods: Data from a multicentric European database were analyzed. All participating centers maintained a prospective database of patients undergoing RARC with ICUD. We identified patients receiving antiplatelet therapy by acetylsalicylic acid <= 100mg. Patients were divided into three groups: those not taking acetylsalicylic acid (no-ASA), those where ASA was continued perioperatively (c-ASA) and those where ASA was interrupted perioperatively (i-ASA). Estimated blood loss and peri-and post-operative transfusions were recorded. Hemorrhagic complications, ischemic, thrombotic and cardiac morbidity was recorded and classified using the Clavien-Dindo score by a senior urologist.Results: 640 patients were analyzed. Patients on acetylsalicylic acid were significantly older and had more comorbidities. No significant difference was found for estimated blood loss between no-ASA, c-ASA and i-ASA (280 vs. 300 vs. 200ml respectively; P = 0.09). Similarly, no significant difference was found for intraoperative (5% vs. 9% vs. 11%; P = 0.07) and postoperative transfusion rate (11% vs. 13% vs. 18%; P = 0.17). Higher ischemic complications were noted in the i-ASA group compared to no-ASA and c-ASA (4% vs. 0.6% vs. 1.4%; P = 0.03). On uni and multivariate logistic regression, continuing acetylsalicylic acid was not significantly associated to either major complications or post-operative transfusions.Conclusions: Peri-operative acetylsalicylic acid continuation in RARC with ICUD does not increase hemorrhagic complications. Interrupting acetylsalicylic acid peri-operatively may expose patients to a higher risk of ischemic events. (C) 2021 Elsevier Inc. All rights reserved.

Continuing acetylsalicylic acid during Robotic-Assisted Radical Cystectomy with intracorporeal urinary diversion does not increase hemorrhagic complications: results from a large multicentric cohort / Albisinni, Simone; Diamand, Romain; Mjaess, Georges; Assenmacher, Gregoire; Assenmacher, Christophe; Loos, Shirley; Verhoest, Gregory; Holz, Serge; Naudin, Michel; Ploussard, Guillaume; Mari, Andrea; Di Maida, Fabrizio; Minervini, Andrea; Aoun, Fouad; Tay, Andrea; Issa, Rami; Roumiguié, Mathieu; Bajeot, Anne Sophie; Simone, Giuseppe; Anceschi, Umberto; Umari, Paolo; Sridhar, Ashwin; Kelly, John; Hendricksen, Kees; Einerhand, Sarah; Sanchez-Salas, Rafael; Colomer, Anna; Quackels, Thierry; Peltier, Alexandre; Montorsi, Francesco; Briganti, Alberto; Pradere, Benjamin; Moschini, Marco; Roumeguère, Thierry. - In: UROLOGIC ONCOLOGY. - ISSN 1078-1439. - ELETTRONICO. - 40:(2022), pp. 163.e11-163.e17. [10.1016/j.urolonc.2021.08.023]

Continuing acetylsalicylic acid during Robotic-Assisted Radical Cystectomy with intracorporeal urinary diversion does not increase hemorrhagic complications: results from a large multicentric cohort

Mari, Andrea;Di Maida, Fabrizio;Minervini, Andrea;
2022

Abstract

Objectives: To evaluate whether continuing the antiplatelet drug acetylsalicylic acid <= 100mg (ASA) during Robotic-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) increases the risk of peri-and postoperative hemorrhagic complications and overall morbidity. Indeed, guidelines recommend interrupting antiplatelet therapy before radical cystectomy; however, RARC with ICUD is associated to reduced estimated blood loss and blood transfusions compared to its open counterpart.Methods: Data from a multicentric European database were analyzed. All participating centers maintained a prospective database of patients undergoing RARC with ICUD. We identified patients receiving antiplatelet therapy by acetylsalicylic acid <= 100mg. Patients were divided into three groups: those not taking acetylsalicylic acid (no-ASA), those where ASA was continued perioperatively (c-ASA) and those where ASA was interrupted perioperatively (i-ASA). Estimated blood loss and peri-and post-operative transfusions were recorded. Hemorrhagic complications, ischemic, thrombotic and cardiac morbidity was recorded and classified using the Clavien-Dindo score by a senior urologist.Results: 640 patients were analyzed. Patients on acetylsalicylic acid were significantly older and had more comorbidities. No significant difference was found for estimated blood loss between no-ASA, c-ASA and i-ASA (280 vs. 300 vs. 200ml respectively; P = 0.09). Similarly, no significant difference was found for intraoperative (5% vs. 9% vs. 11%; P = 0.07) and postoperative transfusion rate (11% vs. 13% vs. 18%; P = 0.17). Higher ischemic complications were noted in the i-ASA group compared to no-ASA and c-ASA (4% vs. 0.6% vs. 1.4%; P = 0.03). On uni and multivariate logistic regression, continuing acetylsalicylic acid was not significantly associated to either major complications or post-operative transfusions.Conclusions: Peri-operative acetylsalicylic acid continuation in RARC with ICUD does not increase hemorrhagic complications. Interrupting acetylsalicylic acid peri-operatively may expose patients to a higher risk of ischemic events. (C) 2021 Elsevier Inc. All rights reserved.
2022
40
163.e11
163.e17
Albisinni, Simone; Diamand, Romain; Mjaess, Georges; Assenmacher, Gregoire; Assenmacher, Christophe; Loos, Shirley; Verhoest, Gregory; Holz, Serge; Na...espandi
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Utilizza questo identificatore per citare o creare un link a questa risorsa: https://hdl.handle.net/2158/1287590
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