1757 ROBOTIC ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY AND CONCURRENT ASPIRIN USE. INITIAL EXPERIENCE

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You have accessJournal of UrologyProstate Cancer: Localized VII1 Apr 20101757 ROBOTIC ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY AND CONCURRENT ASPIRIN USE. INITIAL EXPERIENCE Sepehr Nowfar, Ryan Kopp, Kerrin Palazzi-Churas, Ithaar Derweesh, and Christopher Kane Sepehr NowfarSepehr Nowfar More articles by this author , Ryan KoppRyan Kopp More articles by this author , Kerrin Palazzi-ChurasKerrin Palazzi-Churas More articles by this author , Ithaar DerweeshIthaar Derweesh More articles by this author , and Christopher KaneChristopher Kane More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1606AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES New cardiology guidelines recommend continuous antiplatelet therapy for some patients with cardiac stents. Aspirin use is relatively contraindicated during urologic surgery due to increased bleeding risks. We sought to review the outcomes and risks of aspirin use during robotic assisted laparoscopic radical prostatectomy. METHODS Between September 2007 and April 2009, 176 patients (Group 1) underwent robotic assisted laparoscopic prostatectomy by a single surgeon. Ten patients had coronary artery stents. In consultation with the patients' cardiologists, six patients were allowed to hold aspirin for ten days (Group 2), four patients could not have aspirin held (Group 3). Pre-operative characteristics were analyzed including age, PSA, D'Amico risk as were operative time, blood loss, hematocrit changes, transfusion requirements, length of hospital stay, and Clavien related complications. RESULTS Our three surgical groups showed similar operative time, estimated blood loss, hematocrit changes, and length of hospital stay. No patients in Groups 2 or 3 required blood transfusions nor had significant complications. In our control group, however, 4 patients required interventions for symptomatic lymphoceles. Patients had no sequelae after intervention. CONCLUSIONS Patients with coronary artery stents with life-long antiplatelet medication are at high risk of coronary embolism and sudden death following cessation of aspirin. Our initial experience in robotic prostatectomy with patients on perioperative aspirin show no increased blood loss, operative time, transfusion requirement, hospital stay or operative complications. Larger studies need to be performed to validate these observations Table 1. Demographics, Post-op results and complications No ASA use (n=163) ASA held (n=6) ASA continued (n=4) p-value Mean Age (yr.)±SD 61.7±6.9 67.4±6.2 62.4±7.2 0.143 Mean PSA±SD 6.4±4.4 10.2±6.2 7.1±3 0.121 Biopsy Grade Total - - - 0.457 ≤ 6 97(95.1%) 2(2%) 3(2.9%) - 7 46(93.9%) 2(4.1%) 1(2%) - '8-10 19(90.5%) 2(9.5%) 0(0%) - Clinical T Stage 0.242 T1a-c 108(94.7%) 2(1.8%) 4(3.5%) - T2a-c 50(92.6%) 4(7.4%) 0(0%) - T3a-b 3(100%) 0(0%) 0(0%) - Risk Stratification - - - 0.316 D'Amico Low Risk 90(95.7%) 1(1.1%) 3(3.2%) - D'Amico Intermediate Risk 46(93.9%) 2(4.1%) 1(2%) - D'Amico High Risk 25(89.3%) 3(10.7%) 0(0%) - Mean Preoperative HCT ± SD 44±3.3 43.3±4.1 44.2±3.4 0.856 Mean OR Time (mins) ± SD 182.3±38 174.3±36.1 171 0.898 Mean Estimated Blood Loss (mL) ± SD 153.5±89.5 133.3±28.9 75 0.634 Mean HCT Change ± SD -9±4 -9.2±3.8 -10.6±1 0.790 Patient(s) transfused Post-operatively 5(3.1%) 0(0%) 0(0%) 0.851 Mean Hospital Stay (days) ± SD 1.2±0.8 1.5±0.5 1.3±0.5 0.694 Complications (Clavien Grading) - - - 0.992 Grade 1 8(40%) 3(100%) 1(100%) - Grade 2 8(40%) 0(0%) 0(0%) - Grade 3a 3(15%) 0(0%) 0(0%) - Grade 3b 1(5%) 0(0%) 0(0%) - p value by: Chi2 test, ANOVA using 2-tailed tests Table 2. NSAID continued patient demographic, surgical and post-operative details Patient 1 Patient 2 Patient 3 Patient 4 Age 66 51 65 66 PSA 10.5 8.7 5.7 4.5 Biopsy Grade 4+3 3+3 3+3 3+3 Clinical pre-op Stage T1c T1c T1c T1c OR Time(min) 210 210 160 171 EBL(ml) 200 100 50 75 Hospital Stay(days) 1 1 2 1 Tran