title: Aspirin and clopidogrel during robotic partial nephrectomy, is it safe?
abstract: BACKGROUND
  Continuation of antiplatelet medications through major urologic surgery may increase the risk of intraoperative and postoperative bleeding complications. However, withdrawal of antiplatelet therapy may place some patients at high risk of serious cardiovascular or cerebrovascular complications. We assess the feasibility of performing robotic partial nephrectomy (RPN) in patients maintained on aspirin or dual antiplatelet therapy with aspirin and clopidogrel.
  
  
  METHODS
  Perioperative data was collected prospectively on 230 subjects undergoing RPN enrolled in an IRB approved quality of life study. We analyzed subjects who were maintained on either aspirin alone or both aspirin and clopidogrel throughout the operative and perioperative period.
  
  
  RESULTS
  Of the 230 patients, six were identified who continued antiplatelet medication throughout the perioperative period. Four patients were maintained on 81 mg of aspirin and two patients continued aspirin and clopidogrel. Average RENAL score was 7 with mean tumor size of 4.1 cm. There were no intraoperative complications and no conversions to open surgery. Average estimated blood loss was 242 mL. Ninety day complication rate was 33%. One patient had postoperative bleeding on day 14 after restarting coumadin in addition to their aspirin.
  
  
  CONCLUSIONS
  We present a case series demonstrating that in carefully selected patients, RPN on aspirin and clopidogrel is feasible and safe. This is the first report of patients who underwent RPN while on both aspirin and clopidogrel.
authors.affiliation: Department of Surgery, Division of Urology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: Adam B
authors.initials: AB
authors.lastname: Althaus
authors.forename: Ostap
authors.initials: O
authors.lastname: Dovirak
authors.forename: Peter
authors.initials: P
authors.lastname: Chang
authors.forename: Kimberly N
authors.initials: KN
authors.lastname: Taylor
authors.forename: Thomas D
authors.initials: TD
authors.lastname: O'Halloran
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Wagner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D000077144:Clopidogrel; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D018579:Patient Selection; D059035:Perioperative Period; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000517:prevention & control; D065287:Robotic Surgical Procedures; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D028761:Withholding Treatment
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin