title: Laparoscopic renal-adrenal surgery in patients on oral anticoagulant therapy.
abstract: OBJECTIVE
  Patients requiring chronic anticoagulation are theoretically at increased risk for hemorrhage or thromboembolism perioperatively. Experience with laparoscopic renal/adrenal surgery in patients on chronic warfarin is limited. We assessed hemorrhagic/thromboembolic complications in this group of patients.
  
  
  METHODS
  The records of 787 patients undergoing laparoscopic renal/adrenal surgery were retrospectively reviewed. A total of 25 patients on chronic oral anticoagulation with warfarin were identified. The indications for warfarin therapy as well as perioperative management were reviewed. Clinical parameters, including operative time, estimated blood loss, hemorrhagic/thromboembolic complications and transfusions, were documented and compared with those in patients not receiving chronic anticoagulation.
  
  
  RESULTS
  Atrial fibrillation (56% of cases) and a prosthetic mitral valve (28%) were the most frequent indications for chronic anticoagulation. Bridging anticoagulation with unfractionated heparin was the most frequent management method (68% of cases). Patients with anticoagulation were older (p <0.001) and hospitalized longer (<0.001) than those without anticoagulation. Operative time, estimated blood loss and the conversion rate were not significantly different between the groups. However patients on chronic warfarin significantly more often required transfusion (24% vs 5.2%, p <0.005) and had more postoperative bleeding episodes (8% vs 0.9%, p <0.05) than patients not on chronic anticoagulation. No thromboembolic events occurred in the anticoagulated group, while 3 occurred in the nonanticoagulated group (p = 1).
  
  
  CONCLUSIONS
  Laparoscopic renal/adrenal surgery in patients requiring chronic anticoagulation therapy can be performed safely. The risk of intraoperative bleeding is not increased, although the incidence of postoperative bleeding as well as transfusions is higher.
authors.affiliation: The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Ioannis M
authors.initials: IM
authors.lastname: Varkarakis
authors.forename: Soroush
authors.initials: S
authors.lastname: Rais-Bahrami
authors.forename: Mohamad E
authors.initials: ME
authors.lastname: Allaf
authors.forename: Guilherme C
authors.initials: GC
authors.lastname: Lima
authors.forename: Sompol
authors.initials: S
authors.lastname: Permpongkosol
authors.forename: Pravin
authors.initials: P
authors.lastname: Rao
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Jarrett
authors.forename: Louis R
authors.initials: LR
authors.lastname: Kavoussi
mesh_terms: D000284:Administration, Oral; D000315:Adrenalectomy; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D016063:Blood Loss, Surgical / Q000503:physiopathology; D001803:Blood Transfusion / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D011183:Postoperative Complications / Q000097:blood / Q000139:chemically induced*; D019106:Postoperative Hemorrhage / Q000097:blood / Q000139:chemically induced; D012189:Retrospective Studies; D012306:Risk; D013923:Thromboembolism / Q000097:blood / Q000139:chemically induced; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D014859:Warfarin