title: Perioperative Outcomes Following Partial Nephrectomy Performed on Patients Remaining on Antiplatelet Therapy.
abstract: We evaluated the risk of bleeding complications in patients undergoing partial nephrectomy in whom perioperative antiplatelet therapy was continued, as antiplatelet therapy is increasingly used and hemorrhage is a significant concern in partial nephrectomy.
  
  
  
  In this 2-center retrospective analysis 1,097 patients underwent partial nephrectomy between 2000 and 2014. The cohort was split into 3 groups of perioperative continuation of antiplatelet therapy (group 1-67), antiplatelet therapy stopped preoperatively (group 2-254) and no chronic antiplatelet therapy (group 3-776). Bleeding complications were defined as any transfusion, or any hospital readmission or secondary procedure performed for hemorrhage. Multivariable analysis was performed to elucidate independent risk factors for bleeding complications.
  
  
  
  Patients in group 1 were older (median age 66 years vs 64 and 57 years in groups 2/3, p <0.0001), and had greater comorbidity (median ASA classification score 3 vs 2 and 2, p <0.0001). Group 1 had a higher rate of bleeding complications (20.9% vs 7.1% and 6.4%, p <0.0001) and transfusions (16.4% vs 5.9% and 5.4%, p=0.002). Multivariable analysis revealed continued antiplatelet therapy was an independent predictor of bleeding complications (OR 2.19, 95% CI 1.06-4.51, p=0.03). These findings appear attributable to intraoperative clopidogrel use. On multivariable analysis the use of aspirin alone was not associated with bleeding complications (OR 1.64, 95% CI 0.72-3.75, p=0.24).
  
  
  
  The risk of bleeding complications due to antiplatelet therapy use at partial nephrectomy may be due to clopidogrel. The need to continue perioperative aspirin alone does not appear to be a contraindication to the safe performance of partial nephrectomy.
authors.affiliation: Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Timothy
authors.initials: T
authors.lastname: Ito
authors.affiliation: Department of Urology, University of California San Diego School of Medicine, San Diego, California.
authors.forename: Ithaar H
authors.initials: IH
authors.lastname: Derweesh
authors.affiliation: Department of Urology, Einstein Healthcare Network, Philadelphia, Pennsylvania.
authors.forename: Serge
authors.initials: S
authors.lastname: Ginzburg
authors.affiliation: Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Philip H
authors.initials: PH
authors.lastname: Abbosh
authors.affiliation: Department of Urology, University of California San Diego School of Medicine, San Diego, California.
authors.forename: Omer A
authors.initials: OA
authors.lastname: Raheem
authors.affiliation: Department of Urology, University of California San Diego School of Medicine, San Diego, California.
authors.forename: Hossein
authors.initials: H
authors.lastname: Mirheydar
authors.affiliation: Department of Urology, University of California San Diego School of Medicine, San Diego, California.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Hamilton
authors.affiliation: Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: David Y T
authors.initials: DY
authors.lastname: Chen
authors.affiliation: Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Marc C
authors.initials: MC
authors.lastname: Smaldone
authors.affiliation: Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Greenberg
authors.affiliation: Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Rosalia
authors.initials: R
authors.lastname: Viterbo
authors.affiliation: Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kutikov
authors.affiliation: Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania. Electronic address: robert.uzzo@fccc.edu.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Uzzo
mesh_terms: D000367:Age Factors; D000368:Aged; D001241:Aspirin / Q000009:adverse effects; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D000077144:Clopidogrel / Q000009:adverse effects; D003328:Coronary Thrombosis / Q000517:prevention & control; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects*; D010359:Patient Readmission / Q000706:statistics & numerical data; D059035:Perioperative Period; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D001241:Aspirin
keywords: aspirin; carcinoma; clopidogrel; hemorrhage; nephrectomy; renal cell