title: Open and robot-assisted radical retropubic prostatectomy in men receiving ongoing low-dose aspirin medication: revisiting an old paradigm?
abstract: OBJECTIVE
  To assess blood loss, transfusion rates and 90-day complication rates in patients receiving ongoing 100 mg/day aspirin medication and undergoing open radical prostatectomy (RP) or robot-assisted RP (RARP).
  
  
  METHODS
  Between February 2010 and August 2011, 2061 open RPs and 400 RARPs were performed. All patients received low-molecular-weight heparin for thrombembolism prophylaxis. Aspirin intake during surgery was recorded in 137 patients (5.5%). Descriptive statistics and multivariable analyses after propensity-score matching for balancing potential differences in patients with and without aspirin medication were used to assess the risk of blood loss above the median in patients undergoing open RP or RARP.
  
  
  RESULTS
  The median blood loss in the open RP cohort with and without aspirin medication was 750 and 700 mL, respectively, and in the RARP cohort it was 200 and 150 mL, respectively. Within the same cohorts, transfusions were administered in 21 and 8% and 0 and 1% of patients, respectively. The 90-day complication rates in patients with ongoing aspirin medication were 5.8, 4.4, 7.3 and 0% for Clavien grades I, II, III and IV complications, respectively. In multivariable analyses and after propensity-score matching, prostate volume (odds ratio 1.03; 95% CI 1.02-1.04; P < 0.01) but not ongoing aspirin medication achieved independent predictor status for the risk of blood loss above the median.
  
  
  CONCLUSIONS
  Major surgery such as open RP and RARP can be safely performed in patients with ongoing aspirin medication without greater blood loss. Higher 90-day complication rates were not detected in such patients. Differences in transfusion rates between the groups receiving and not receiving ongoing aspirin medication may be explained by a higher proportion of patients with coronary artery disease in the group receiving ongoing aspirin medication. This comorbidity may result in a higher peri-operative threshold for allogenic blood transfusion.
authors.affiliation: Martini Clinic, Prostate Cancer Center at University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Sami-Ramzi
authors.initials: SR
authors.lastname: Leyh-Bannurah
authors.forename: Jens
authors.initials: J
authors.lastname: Hansen
authors.forename: Hendrik
authors.initials: H
authors.lastname: Isbarn
authors.forename: Thomas
authors.initials: T
authors.lastname: Steuber
authors.forename: Pierre
authors.initials: P
authors.lastname: Tennstedt
authors.forename: Uwe
authors.initials: U
authors.lastname: Michl
authors.forename: Thorsten
authors.initials: T
authors.lastname: Schlomm
authors.forename: Alexander
authors.initials: A
authors.lastname: Haese
authors.forename: Hans
authors.initials: H
authors.lastname: Heinzer
authors.forename: Hartwig
authors.initials: H
authors.lastname: Huland
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.forename: Lars
authors.initials: L
authors.lastname: Budäus
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D003327:Coronary Disease / Q000150:complications / Q000188:drug therapy*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000009:adverse effects*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000517:prevention & control; D011322:Primary Prevention / Q000379:methods; D057216:Propensity Score; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000150:complications / Q000601:surgery*; D012306:Risk; D012371:Robotics / Q000379:methods; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
keywords: aspirin; blood loss; complication rates; prostate cancer; prostatectomy; robot-assisted; transfusion