Risks and complications of robot-assisted radical prostatectomy (RARP) in patients receiving antiplatelet and/or anticoagulant therapy: a retrospective cohort study in a single institute

Masashi Oshima,Kimitoshi Saito,Tomoaki Miyagawa,Yuhki Nakamura,Yoshiaki Arai,Tsuzumi Konishi,Satoshi Washino

doi:10.1007/s11701-020-01154-8

Abstract

The objective of the study was to evaluate the risk of bleeding complications in patients undergoing robot-assisted radical prostatectomy (RARP) while taking antiplatelet (AP) and/or anticoagulant (AC) agents. We analyzed the data of 334 patients undergoing RARP from May 2015 to May 2019. Patients were categorized into AP, AC, and control groups; the bleeding complications were compared among them. The end points were the estimated blood loss, decrease in hemoglobin level, and bleeding complications. The patient characteristics did not differ significantly among groups, with the exception of ASA scores, which were significantly higher in the AP and AC groups vs. the control group. The estimated blood loss and hemoglobin decrease were not significantly different between the AP and AC groups and the control group. The frequency of bleeding complications did not differ significantly between the AP and the control groups, but was significantly higher in the AC vs. the control group (4.3% in the AP and 23.5% in the AC group vs. 3.7% in the control group; P = 0.63 and P < 0.01, respectively). There was no significant difference in bleeding complications between the AP continuation (continuation of a single AP) and the AP interruption group or between the heparin bridging and the AC interruption group. All bleeding complications observed in the AC group occurred after resuming AC therapy. RARP can be performed safely with continuation of a single AP, and in patients taking ACs by interrupting these agents or via heparin bridging, without increasing intraoperative bleeding, whereas postoperative bleeding complications may increase after resuming ACs.

Highlights

The aging of the population has led to an increase in cardiovascular conditions and in the intake of oral antiplatelet (AP) and/or anticoagulant (AC) drugs [1]
In the seven patients taking double AP therapy (DAPT), one AP was interrupted prior to the surgery, while aspirin alone was continued in the perioperative period
The present study demonstrated that robot-assisted radical prostatectomy (RARP) was performed safely without increasing bleeding complications in patients taking APs with continuation of a single AP

Summary

Introduction

The aging of the population has led to an increase in cardiovascular conditions and in the intake of oral antiplatelet (AP) and/or anticoagulant (AC) drugs [1]. It is difficult for clinicians to handle patients taking these medications when a surgical intervention is considered. There is a dilemma between the bleeding risk if they are continued during the procedure and the thromboembolitic risk associated with their discontinuation. Most urological endoscopic and surgical procedures have a significant bleeding risk, and clinicians need. The use of robot-assisted radical prostatectomy (RARP) for prostate cancer has spread rapidly worldwide [4]. The number of patients taking APs and/or ACs has increased. It has become important to handle APs and/or ACs safely in patients undergoing RARP

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