title: Risks and complications of transurethral resection of bladder tumor among patients taking antiplatelet agents for cardiovascular disease.
abstract: BACKGROUND
  Urologists have not reached a consensus regarding the pre-, intra-, and postoperative management of patients taking antiplatelet agents. This study aimed to evaluate the clinical course of patients receiving antithrombotic monotherapy with acetylsalicylic acid (ASA) 100 mg who underwent transurethral resection of bladder cancer.
  
  
  METHODS
  This study was designed to compare the surgical outcomes for 108 transurethral resections of bladder cancer performed for patients taking antiplatelet therapy and for 105 procedures performed for patients who had never taken antiplatelet agents before surgery. Antiaggregant therapy was maintained according to criteria evaluated by a urologist, surgeon, anesthesiologist, and cardiologist. Variables were described using the mean as the location index and using standard deviation as a dispersion index if continuous percentages were used elsewhere. Group comparisons were performed using the t test or the chi-square test for categorical data, and Fisher's exact test was used where appropriate.
  
  
  RESULTS
  The mean operative time for patients taking ASA was 31 min (range 10-65 min), whereas it was 26 min (range 5-60 min) for control subjects. The difference between pre- and postoperative hemoglobin values was -0.6 g/dl in the group receiving antiplatelet therapy and -0.8 g/dl in the control group (p = 0.0720). Transfusional support was required during four procedures performed for patients taking antiplatelet therapy and during two procedures for the control group (p = 0.242). No adverse cardiac events or anesthesia-related complications occurred. Three patients in the treatment group and two patients in the control group required reintervention to ensure hemostasis during the postoperative period. None of the patients in either group underwent rehospitalization for hematuria after leaving the hospital.
  
  
  CONCLUSIONS
  The current results suggest that continued use of anti-aggregant monotherapy does not increase the risk of overall bleeding or reintervention for patients undergoing transurethral resection of bladder neoplasms and that suspending aspirin before such a procedure is therefore unnecessary.
authors.affiliation: Urology Department, IRCCS Policlinico San Donato, University of Milan, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy, stepico@tin.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Picozzi
authors.forename: Carlo
authors.initials: C
authors.lastname: Marenghi
authors.forename: Cristian
authors.initials: C
authors.lastname: Ricci
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bozzini
authors.forename: Stefano
authors.initials: S
authors.lastname: Casellato
authors.forename: Luca
authors.initials: L
authors.lastname: Carmignani
mesh_terms: D000368:Aged; D001241:Aspirin / Q000009:adverse effects* / Q000627:therapeutic use; D001803:Blood Transfusion; D002318:Cardiovascular Diseases / Q000150:complications* / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced* / Q000517:prevention & control; D006801:Humans; D008297:Male; D061646:Operative Time; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D011182:Postoperative Care; D018570:Risk Assessment; D001749:Urinary Bladder Neoplasms / Q000150:complications* / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects*
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin