OBJECTIVE: An increasing proportion of prostate cancer patients daily require low-dose aspirin medication based on cardiac comorbidities.
Although a life expectancy of more than ten years can easily be achieved, surgeons are traditionally reluctant to perform major surgery on such patients. We aimed to assess blood loss, transfusion rates and 90-days complication rates in patients with ongoing 100mg/d aspirin medication during open radical prostatectomy (RP) and robot assisted RP (RARP).
MATERIAL AND METHODS: Between 2/2010 and 8/2011, 2061 RPs and 400 RARPs were performed. All patients received low-molecular-weight-heparin (LMWH) for thrombembolism prophylaxis. Aspirin intake during operation was recorded in 137 patients (5.5%). Descriptive statistics and multivariable analyses after propensity score matching for balancing potential differences in patients with and without aspirin medication addressed the risk of blood loss above the median in RP and RARP patients.
RESULTS: Median blood loss in RP and RARP patients with and without aspirin medication was 750ml and 700ml respectively 200ml and 150ml. Within the same groups, transfusions were administered in 21%, 8% and 0% and 1% of patients. The 90-days complication rates in patients with ongoing aspirin medication were 5.8%, 4.4%, 7.3% and 0% for Clavien grade I, II, III and IV complications. In multivariable analyses and propensity score matching, prostate volume (OR 1.03; 95% C.I.: 1.02-1.04; p< 0.01) but not ongoing aspirin medication achieved independent predictor status for the risk of blood loss above the median.
CONCLUSIONS: Major surgery like RP and RARP can be safely performed in patients with ongoing aspirin medication without increased blood loss. Moreover, no increased 90-days complication rates were detected. Differences in transfusion rates between both groups may be explained by a higher proportion of patients suffering from coronary artery disease. These comorbidities may result in a higher perioperative cut off for allogenic blood transfusion.
Written by:
Leyh-Bannurah SR, Hansen J, Isbarn H, Steuber T, Tennstedt P, Michl U, Schlomm T, Haese A, Heinzer H, Huland H, Graefen M, Budäus L. Are you the author?
Martini Clinic, Prostate Cancer Center at University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Reference: BJU Int. 2013 Oct 15. Epub ahead of print.
doi: 10.1111/bju.12504
PubMed Abstract
PMID: 24127902
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