Impact of Anticoagulant and Antiplatelet Drugs on Perioperative Outcomes of Robotic-assisted Partial Nephrectomy.
OBJECTIVE
To evaluate the impact of anticoagulant (AC) or antiplatelet (AP) therapy on the morbidity of robot-assisted partial nephrectomy (RAPN).


METHODS
From 2011 to 2015, we retrospectively analyzed a prospectively maintained institutional review board-approved database of RAPN from 2 academic departments of urology. We evaluated the occurrence of overall complications and hemorrhagic complications (pseudoaneurysm, arteriovenous fistula, hematoma, transfusion). Patients with therapeutic AC or AP, stopped or not before surgery, were compared with patients without therapeutic AC or AP. A logistic regression model was used to identify predictors of complications.


RESULTS
Out of 533 patients who underwent RAPN, 70 had AC or AP (50% aspirin, 25% clopidogrel, 28% AC, 8% direct oral AC). Clopidogrel, AC, and direct oral AC were always stopped preoperatively. Aspirin was continued in 25% of the cases. In univariate analysis, overall complications (39.2% vs 17.4%; P = .001) and hemorrhagic complications (32.7% vs 9.6%; P <.001) were higher in patients on AC or AP. Hospital stay was longer in the group with therapeutic AC or AP treatment (5.1 vs 3.9 days; P <.001). In multivariate analysis, predictors of complications were intake of therapeutic AC (odds ratio [OR] = 4.3, IC95% [1.2-15.9], P = .03) and tumor size (OR = 1.8, IC95% [1.3-7.2], P = .03). Patients on aspirin tended to have more complications (OR = 2.4; IC95% [0.4-9.3]; P = .15).


CONCLUSIONS
AP and therapeutic AC increase the morbidity of RAPN. These treatments should be taken into account in treatment decision-making algorithm of small renal masses.
Service d'Urologie, CHU Rennes, Rennes, France. Electronic address: benjaminpradere@gmail.com.
Benjamin
B
Pradere
Service d'Urologie, CHU Rennes, Rennes, France.
Benoit
B
Peyronnet
Service d'Urologie, Hopital Pitié-Salpétrière, Paris, France.
Thomas
T
Seisen
Service d'Urologie, CHU Rennes, Rennes, France.
Zineddine
Z
Khene
Service d'Urologie, Hopital Pitié-Salpétrière, Paris, France.
Marina
M
Ruggiero
Service d'Urologie, Hopital Pitié-Salpétrière, Paris, France.
Christophe
C
Vaessen
Service d'Urologie, CHU Rennes, Rennes, France.
Grégory
G
Verhoest
Service d'Urologie, CHU Rennes, Rennes, France.
Romain
R
Mathieu
Service d'Urologie, Hopital Pitié-Salpétrière, Paris, France.
Morgan
M
Roupret
Service d'Urologie, CHU Rennes, Rennes, France.
Karim
K
Bensalah
D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D001241:Aspirin / Q000008:administration & dosage*; D000077144:Clopidogrel; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009392:Nephrectomy; D019990:Perioperative Care / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin