Perioperative Outcomes Following Partial Nephrectomy Performed on Patients Remaining on Antiplatelet Therapy

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• 作者：Timothy Ito^a ; Ithaar H. Derweesh^c ; Serge Ginzburg^b ; Philip H. Abbosh^a ; Omer A. Raheem^c ; Hossein Mirheydar^c ; Zachary Hamilton^c ; David Y.T. Chen^a ; Marc C. Smaldone^a ; Richard E. Greenberg^a ; Rosalia Viterbo^a ; Alexander Kutikov^a ; Robert G. Uzzo^a ; ^{robert.uzzo@fccc.edu}
• 关键词：aspirin ; carcinoma ; renal cell ; clopidogrel ; hemorrhage ; nephrectomy
• 刊名：The Journal of Urology
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：197
• 期：1
• 页码：31-36
• 全文大小：129 K
• 卷排序：197

文摘

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 MethodsIn 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.ResultsPatients 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).ConclusionsThe 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.