title: Robotic-assisted radical prostatectomy in patients receiving chronic anticoagulation therapy: role of perioperative bridging.
abstract: OBJECTIVE
  Patients requiring chronic anticoagulation therapy (CAT) with warfarin require special attention perioperatively. We retrospectively reviewed our experience of treating patients requiring CAT who underwent robotic-assisted radical prostatectomy (RARP) to evaluate the role of perioperative bridging therapy.
  
  
  METHODS
  A total of 60 patients receiving cat with warfarin who underwent rarp were identified as having been treated using 1 of 2 protocols: protocol 1, the cessation of CAT 7 days before surgery and its resumption the evening of catheter removal (postoperative day 4-21); or protocol 2, warfarin substituted with perioperative subcutaneous low-molecular-weight heparin, with oral anticoagulation restarted after catheter removal. The decision to use perioperative bridging was made in conjunction with the patient's primary care physician. The peri- and postoperative parameters and complications were compared with a matched control group of 181 contemporary patients who underwent RARP but did not require CAT.
  
  
  RESULTS
  The most common indications for CAT were atrial fibrillation (58%) and recurrent deep vein thrombosis (22%). Compared with the control cohort, the patients with CAT had an increased operative time (189 vs 170 minutes, P = .005) and hospital stay (1.4 vs 1.1 days, P = .004). The estimated blood loss (123.9 vs 146.6 mL, P = .07) and 24-hour change in hemoglobin (2.2 vs 2.3 g/dL, P = .44) were similar. When comparing the 2 protocols, a significantly greater transfusion rate (23% vs 2%, P = .042) occurred with protocol 2, but no increase was seen in the complication or readmission rate. One nonfatal thromboembolic event occurred in 1 patient treated using protocol 1.
  
  
  CONCLUSIONS
  The results of our study have shown that RARP can be performed safely in patients requiring CAT, with and without bridging therapy. Patients in protocol 2 had greater transfusion rates, but this did not translate into increased complications or readmissions.
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health Systems, Detroit, Michigan 48202, USA. lkrane@hfhs.org
authors.forename: L Spencer
authors.initials: LS
authors.lastname: Krane
authors.forename: Rajesh
authors.initials: R
authors.lastname: Laungani
authors.forename: Ramgopal
authors.initials: R
authors.lastname: Satyanarayana
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Kaul
authors.forename: Mahendra
authors.initials: M
authors.lastname: Bhandari
authors.forename: James O
authors.initials: JO
authors.lastname: Peabody
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D018572:Disease-Free Survival; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000295:instrumentation* / Q000379:methods*; D011471:Prostatic Neoplasms / Q000150:complications* / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D012371:Robotics; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin