Outcomes of Partial Nephrectomy in Patients on Chronic Oral Anticoagulant Therapy

Abstract

We report our experience with patients requiring long-term anticoagulation therapy who underwent open or laparoscopic partial nephrectomy for renal tumors at our institution. We compared outcomes with those in a control group undergoing partial nephrectomy with no anticoagulation requirements. We retrospectively reviewed the records of 1,031 patients who underwent laparoscopic or open partial nephrectomy from 2000 to 2005. Since 2000, 31 open and 16 laparoscopic partial nephrectomies were performed in patients on chronic warfarin, clopidogrel or cilostazol. Anticoagulation was appropriately discontinued perioperatively. The 47 anticoagulated cases were compared with 47 nonanticoagulated controls that were carefully matched for surgical approach, partial nephrectomy defect size, tumor size and location, procedure year and warm ischemia time. Investigators were blinded to all clinical outcomes throughout the matching process. Bleeding and thrombotic outcomes were then analyzed. The 2 groups were well matched for resection bed size, tumor size, tumor location (central vs peripheral), solitary kidney, operative time and warm ischemia time (each p >or=0.3). Controls had significantly higher intraoperative blood loss (300 vs 200, p <0.05) and a greater postoperative decrease in hemoglobin (3.5 vs 2.4 mg/dl, p <0.001). However, transfusion rates were similar in the 2 groups (each 15%). Five patients on anticoagulation had thrombotic events postoperatively vs none in the control group. Patients on anticoagulation are at higher perioperative risk but with careful perioperative management of anticoagulation therapy partial nephrectomy can be performed in a safe and efficacious manner. To our knowledge this is the largest study of outcomes in this complex patient population.