Aspirin Does Not Hike Kidney Surgery Bleeding Complications

Perioperative aspirin use in patients undergoing RPN does not increase the risk of bleeding complications.
Perioperative aspirin use in patients undergoing RPN does not increase the risk of bleeding complications.

Perioperative administration of aspirin for patients undergoing robotic partial nephrectomy (RPN) does not significantly increase the overall risk of bleeding complications, new data suggest.

Vignesh T. Packiam, MD, and colleagues at the University of Chicago reviewed data from 214 patients who underwent RPN at their institution from May 2012 to March 2015. They compared 49 patients continuing aspirin at a dose of 81 mg, 34 patients holding aspirin for at least 7 days prior to surgery, and 131 patients who had never taken aspirin. Overall bleeding complications included a greater than 3 g/dL drop in postoperative hemoglobin during admission, postoperative blood transfusion, or necessity for urgent selective angiographic embolization.

Patients who continued aspirin had a rate of overall bleeding complications that did not differ significantly from those who held or never took aspirin (27% vs 15% vs 14%), Dr. Packiam's team reported online ahead of print in the Journal of Endourology. The rates also did not differ significantly with respect to a hemoglobin drop greater than 3 g/dL (24% vs 15% vs 14%, and postoperative blood transfusion (4% vs 3% vs 2%).

The 3 groups did not differ significant with regard to estimated blood loss, operating room time, or intravenous fluid administration, according to the investigators.

On multivariate analysis controlling for Charlson Comorbidity Index (CCI) and RENAL nephrometry score, aspirin administration was not significantly associated with bleeding complications, although continuation of aspirin was associated with a higher rate of overall 30-day complications compared with those who held or never took aspirin (24% vs 12% vs 8%). They also had a higher rate of Clavien 3–4 complications (10% vs 6% vs 1.5%).

“We demonstrate that continuing perioperative aspirin was not associated with significantly higher bleeding complications,” the investigators wrote. “To our knowledge, this series evaluates the largest group of patients continuing aspirin for partial nephrectomy to date.”

Patients who continued aspirin had higher overall CCI than those who held or never took aspirin (median 5 vs 4 vs 2). They also had a higher proportion of patients with specific vascular comorbidities, including coronary artery disease, peripheral vascular disease, myocardial infarction, hypertension, and congestive heart failure.

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