title: Continuous low-dose aspirin therapy in robotic-assisted laparoscopic radical prostatectomy does not increase risk of surgical hemorrhage.
abstract: BACKGROUND
  Withdrawal of oral antiplatelet therapy (OAT) is a major risk factor for stent thrombosis, myocardial infarction, and cerebral strokes. In order to minimize the risk for thrombotic complications, since 2007 robotic-assisted laparoscopic radical prostatectomy (RARP) has taken place under continuous OAT with aspirin at our institution. In this retrospective study we analyzed the risk for perioperative bleeding and surgical outcome after RARP with OAT.
  
  
  METHODS
  All patients who underwent RARP with aspirin OAT at our institution since 2007 were included in this analysis. The OAT group was compared with a group that underwent RARP without OAT, which contained twice the number of patients. Matching of the two groups was performed with regard to the tumor stage and whether a lymph node dissection or nerve-sparing was performed.
  
  
  RESULTS
  Thirty-eight patients were assigned to the OAT group and 76 to the control group. A difference in the decrease of postoperative hemoglobin concentration was not detectable between the two groups (mean drop of 2.9±1.4 g/dL and 2.9±1.1 g/dL, respectively; P=.93). RARP was completed in all OAT patients without conversion to open surgery. Two of the 38 patients (5.3%) in the OAT group and none in the control group required blood transfusions (P=.11). Equivalent rates of positive surgical margins for pT2 tumors were detected (16% OAT versus 14% control group; P=1.0). No adverse cardiovascular events occurred in either group during the hospitalization.
  
  
  CONCLUSIONS
  Continued perioperative OAT with aspirin in RARP is safe, feasible, and not associated with increased blood loss.
authors.affiliation: Department of Urology, University Hospital Zürich, Zürich, Switzerland.
authors.forename: Ashkan
authors.initials: A
authors.lastname: Mortezavi
authors.forename: Thomas
authors.initials: T
authors.lastname: Hermanns
authors.forename: Lukas J
authors.initials: LJ
authors.lastname: Hefermehl
authors.forename: Donat R
authors.initials: DR
authors.lastname: Spahn
authors.forename: Burkhardt
authors.initials: B
authors.lastname: Seifert
authors.forename: Damian
authors.initials: D
authors.lastname: Weber
authors.forename: Simone
authors.initials: S
authors.lastname: Brunnschweiler
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Schmid
authors.forename: Tullio
authors.initials: T
authors.lastname: Sulser
authors.forename: Daniel
authors.initials: D
authors.lastname: Eberli
mesh_terms: D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology*; D011468:Prostatectomy / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012371:Robotics; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin