Albisinni Simone, Diamand Romain, Mjaess Georges, Assenmacher Gregoire, Assenmacher Christophe, Loos Shirley, Verhoest Gregory, Holz Serge, Naudin Michel, Ploussard Guillaume, Mari Andrea, Di Maida Fabrizio, Minervini Andrea, Aoun Fouad, Tay Andrea, Issa Rami, Roumiguié Mathieu, Bajeot Anne Sophie, Simone Giuseppe, Anceschi Umberto, Umari Paolo, Sridhar Ashwin, Kelly John, Hendricksen Kees, Einerhand Sarah, Sanchez-Salas Rafael, Colomer Anna, Quackels Thierry, Peltier Alexandre, Montorsi Francesco, Briganti Alberto, Pradere Benjamin, Moschini Marco, Roumeguère Thierry
Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
Urol Oncol. 2022 Apr;40(4):163.e11-163.e17. doi: 10.1016/j.urolonc.2021.08.023. Epub 2021 Sep 25.
To evaluate whether continuing the antiplatelet drug acetylsalicylic acid≤100mg (ASA) during Robotic-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) increases the risk of peri-and postoperative hemorrhagic complications and overall morbidity. Indeed, guidelines recommend interrupting antiplatelet therapy before radical cystectomy; however, RARC with ICUD is associated to reduced estimated blood loss and blood transfusions compared to its open counterpart.
Data from a multicentric European database were analyzed. All participating centers maintained a prospective database of patients undergoing RARC with ICUD. We identified patients receiving antiplatelet therapy by acetylsalicylic acid ≤100mg. Patients were divided into three groups: those not taking acetylsalicylic acid (no-ASA), those where ASA was continued perioperatively (c-ASA) and those where ASA was interrupted perioperatively (i-ASA). Estimated blood loss and peri-and post-operative transfusions were recorded. Hemorrhagic complications, ischemic, thrombotic and cardiac morbidity was recorded and classified using the Clavien-Dindo score by a senior urologist.
640 patients were analyzed. Patients on acetylsalicylic acid were significantly older and had more comorbidities. No significant difference was found for estimated blood loss between no-ASA, c-ASA and i-ASA (280 vs. 300 vs. 200ml respectively; P = 0.09). Similarly, no significant difference was found for intraoperative (5% vs. 9% vs. 11%; P = 0.07) and postoperative transfusion rate (11% vs. 13% vs. 18%; P = 0.17). Higher ischemic complications were noted in the i-ASA group compared to no-ASA and c-ASA (4% vs. 0.6% vs. 1.4%; P = 0.03). On uni and multivariate logistic regression, continuing acetylsalicylic acid was not significantly associated to either major complications or post-operative transfusions.
Peri-operative acetylsalicylic acid continuation in RARC with ICUD does not increase hemorrhagic complications. Interrupting acetylsalicylic acid peri-operatively may expose patients to a higher risk of ischemic events.
评估在机器人辅助根治性膀胱切除术（RARC）联合体内尿流改道（ICUD）过程中继续使用≤100mg的抗血小板药物乙酰水杨酸（ASA）是否会增加围手术期和术后出血并发症及总体发病率的风险。事实上，指南建议在根治性膀胱切除术之前中断抗血小板治疗；然而，与开放手术相比，RARC联合ICUD与估计失血量和输血减少有关。
分析了来自一个多中心欧洲数据库的数据。所有参与中心都维护了接受RARC联合ICUD治疗患者的前瞻性数据库。我们确定了接受≤100mg乙酰水杨酸抗血小板治疗的患者。患者分为三组：未服用乙酰水杨酸的患者（无ASA组）、围手术期继续使用ASA的患者（c-ASA组）和围手术期中断使用ASA的患者（i-ASA组）。记录估计失血量以及围手术期和术后输血情况。由一位资深泌尿外科医生使用Clavien-Dindo评分记录并分类出血并发症、缺血性、血栓性和心脏发病率。
分析了640例患者。服用乙酰水杨酸的患者年龄显著更大且合并症更多。无ASA组、c-ASA组和i-ASA组之间在估计失血量方面未发现显著差异（分别为280ml、300ml和200ml；P = 0.09）。同样，在术中输血率（5% vs. 9% vs. 11%；P = 0.07）和术后输血率方面也未发现显著差异（11% vs. 13% vs. 18%；P = 0.17）。与无ASA组和c-ASA组相比，i-ASA组的缺血性并发症更高（4% vs. 0.6% vs. 1.4%；P = 0.03）。在单因素和多因素逻辑回归分析中，继续使用乙酰水杨酸与主要并发症或术后输血均无显著关联。
在RARC联合ICUD手术中围手术期继续使用乙酰水杨酸不会增加出血并发症。围手术期中断使用乙酰水杨酸可能会使患者面临更高的缺血事件风险。
