1805 PARTIAL NEPHRECTOMY IN THE SETTING OF ANTIPLATELET THERAPY: A MULTICENTER COMPARATIVE ANALYSIS (2013)

You have accessJournal of UrologyKidney Cancer: Localized (V)1 Apr 20131805 PARTIAL NEPHRECTOMY IN THE SETTING OF ANTIPLATELET THERAPY: A MULTICENTER COMPARATIVE ANALYSIS Ithaar H. Derweesh, Hossein S. Mirheydar, Jeffrey Tomaszewski, Michael A. Liss, Ramzi Jabaji, Ryan P. Kopp, David M. Sisul, Kerrin L. Palazzi, and Robert G. Uzzo Ithaar H. DerweeshIthaar H. Derweesh La Jolla, CA More articles by this author , Hossein S. MirheydarHossein S. Mirheydar La Jolla, CA More articles by this author , Jeffrey TomaszewskiJeffrey Tomaszewski Philadelphia, PA More articles by this author , Michael A. LissMichael A. Liss La Jolla, CA More articles by this author , Ramzi JabajiRamzi Jabaji La Jolla, CA More articles by this author , Ryan P. KoppRyan P. Kopp La Jolla, CA More articles by this author , David M. SisulDavid M. Sisul La Jolla, CA More articles by this author , Kerrin L. PalazziKerrin L. Palazzi La Jolla, CA More articles by this author , and Robert G. UzzoRobert G. Uzzo Philadelphia, PA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2855AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Increasing use of antiplatelet agents (APA) among patients presenting for urologic surgery has prompted concern. More so, outcomes data regarding APA (aspirin or clopidogrel) in patients undergoing partial nephrectomy (PN), which has a significant hemorrhage risk, are sparse. We sought to compare outcomes of patients undergoing PN who continued APA during the perioperative period, versus those who had a short term perioperative discontinuation, or who were not on APA. METHODS IRB-approved multi-institutional retrospective analysis of patients undergoing PN from 3/2006-10/2012. The cohort was divided into three groups based on utilization of APA therapy: Group I (not on antiplatelet medication), Group II (antiplatelet medication held perioperatively) and Group III (continued antiplatelet medication during surgery). Demographics, clinicopathologic variables, and perioperative blood transfusion rates and complications (Clavien grade) were compared between Groups I/II vs. Group III. Primary outcome was rate of blood transfusion. Multivariable analysis (MVA) was conducted to elucidate factors associated with development of complications ≤30 days following surgery. RESULTS 320 patients met inclusion criteria, 289 in Groups I/II combined, and 31 in Group III. There was no difference between groups for median tumor size on CT (Group I/II 3.0/2.4 vs. Group III 3.0 cm, p=0.416), and mean RENAL score (p=0.198). Group III had significantly longer mean operative time (222 vs. 182/185 minutes for Groups I/II, p=0.008) and higher median estimated blood loss (300 vs. 200/200 mL Group I/II, p=0.002). Compared to combined Group I/II, Group III had significantly higher transfusion rate (25.8% vs. 11.1%, p=0.039). High grade complications (p=0.399) and urine leak (0.493) were not significantly different; however, Group III had significantly increased rate of hematoma (19.4% vs. Group I/II, 3.1%, p=0.001). MVA identified increasing RENAL score (OR 1.32, p=0.001) and blood transfusion (OR 22.4, p<0.001) as risk factors independently associated with complication ≤30 days. CONCLUSIONS Patients who continued APA had significantly higher blood transfusion and hematoma rates but not a significant increase in high grade complications. Occurrence of complications was associated with increasing RENAL score and receipt of blood transfusion. Further data are necessary to calibrate and stratify risks associated with APA therapy in a wider PN population. However, it seems reasonable not to preclude PN in select patients who must otherwise remain on APA. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e742 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ithaar H. Derweesh La Jolla, CA More articles by this author Hossein S. Mirheydar La Jolla, CA More articles by this author Jeffrey Tomaszewski Philadelphia, PA More articles by this author Michael A. Liss La Jolla, CA More articles by this author Ramzi Jabaji La Jolla, CA More articles by this author Ryan P. Kopp La Jolla, CA More articles by this author David M. Sisul La Jolla, CA More articles by this author Kerrin L. Palazzi La Jolla, CA More articles by this author Robert G. Uzzo Philadelphia, PA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...