Radical Prostatectomy With Robot-assisted Radical Prostatectomy and Laparoscopic Radical Prostatectomy Under Low-dose Aspirin Does Not Significantly Increase Blood Loss

Abstract

To determine whether maintaining use of low-dose aspirin confers a higher risk of bleeding events in patients undergoing laparoscopic or robot-assisted radical prostatectomy. There is no consensus on maintaining or withdrawing aspirin in these patients. Consecutive patients undergoing laparoscopic and robot-assisted radical prostatectomy between January 2009 and December 2010 were included in a prospective cohort study. Among them, 54 aspirin-treated patients were compared with 569 non-aspirin-treated patients. We evaluated the between-group difference in bleeding event: intraoperative blood loss ≥ 700 ml and/or need for transfusion and/or postoperative hemorrhagic complication (symptomatic abdominal wall hematomas, major bleeding requiring reoperation). Differences in each component of the bleeding event, in hemoglobin level changes, and hospital stay length were also evaluated. Patients' data were compared using the χ(2) or Fisher exact test for categorical variables and the Student t test or Mann-Whitney test for continuous variables. A bleeding event occurred in 18 (33.3%) aspirin-treated patients and 176 (32.5%) non-aspirin-treated patients (P = .66). Median blood loss was similar in the 2 groups (aspirin: 450 ml, 50-7100 ml; no aspirin: 450 ml, 100-2800 ml; P = .93). Aspirin was not associated with a significant hemoglobin level variation (median decrease, 2.9 g/dL with aspirin and 3.2 g/dL without aspirin, P = .23). Median hospital length of stay, rates of blood transfusion, and postoperative hemorrhagic complications were similar in the 2 groups. Laparoscopic and robot-assisted radical prostatectomy can be performed safely without discontinuing aspirin, as this policy does not increase significantly blood loss, blood transfusion requirements, postoperative hemorrhagic complications. or hospital length of stay.