Identifiable Factors in Post‐prostatectomy Haemorrhage: the Role of Aspirin

Cj, Watson; Deane, Adam M; Doyle, P. T.; Bullock, K. N.

doi:10.1111/j.1464-410x.1990.tb14870.x

Cited by 86 publications

(45 citation statements)

References 16 publications

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“…Many previous studies have addressed the question of factors influencing TURP bleeding [3, 4, 5, 6, 7, 8, 9, 10]. Each study usually addressed a few factors (usually 2–5), and different studies used different methods of blood estimation, making comparison of studies or extrapolation of results difficult.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, many of the so far studied factors are still controversial, being associated with bleeding in some studies and denied such association in others. Such factors include age of patient and mean blood pressure [8], operating time [5, 6], type of anaesthesia [4, 6], gland histology [6, 9]and many others. In this prospective study, we aim at finding out whether any of a set of predefined clinical and laboratory parameters correlate with blood loss caused by TURP.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Risk Factors in Prostatectomy Bleeding: Preoperative Urinary Infection is the only Reversible Factor

El-Malik

Aliyu²,

Gahli³

et al. 2000

European Urology

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risk Factors in Prostatectomy Bleeding: Preoperative Urinary Infection is the only Reversible Factor

El-Malik

Aliyu²,

Gahli³

et al. 2000

European Urology

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“…4,20 Previously, a retrospective analysis of patients undergoing open radical retropubic prostatectomy in 1990 detected a higher risk for bleeding in 52 aspirin-treated patients. 21 Because of ambiguous data about the safety of transurethral resection of the prostate (conventional electroresection), the recommendations for prostate surgery do not provide definite advice. 10,22,23 Considering the reports on blood loss in non-OAT patients, laparoscopic radical prostatectomy and RARP seemed to be promising techniques for the reduction of hemorrhagic complications.…”

Section: Discussionmentioning

confidence: 99%

Continuous Low-Dose Aspirin Therapy in Robotic-Assisted Laparoscopic Radical Prostatectomy Does Not Increase Risk of Surgical Hemorrhage

Mortezavi

Hermanns

Hefermehl

et al. 2013

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Background: Withdrawal of oral antiplatelet therapy (OAT) is a major risk factor for stent thrombosis, myocardial infarction, and cerebral strokes. In order to minimize the risk for thrombotic complications, since 2007 robotic-assisted laparoscopic radical prostatectomy (RARP) has taken place under continuous OAT with aspirin at our institution. In this retrospective study we analyzed the risk for perioperative bleeding and surgical outcome after RARP with OAT. Patients and Methods: All patients who underwent RARP with aspirin OAT at our institution since 2007 were included in this analysis. The OAT group was compared with a group that underwent RARP without OAT, which contained twice the number of patients. Matching of the two groups was performed with regard to the tumor stage and whether a lymph node dissection or nerve-sparing was performed. Results: Thirty-eight patients were assigned to the OAT group and 76 to the control group. A difference in the decrease of postoperative hemoglobin concentration was not detectable between the two groups (mean drop of 2.9±1.4 g/dL and 2.9±1.1 g/dL, respectively; P=.93). RARP was completed in all OAT patients without conversion to open surgery. Two of the 38 patients (5.3%) in the OAT group and none in the control group required blood transfusions (P=.11). Equivalent rates of positive surgical margins for pT2 tumors were detected (16% OAT versus 14% control group; P=1.0). No adverse cardiovascular events occurred in either group during the hospitalization. Conclusions: Continued perioperative OAT with aspirin in RARP is safe, feasible, and not associated with increased blood loss. Background: Withdrawal of oral antiplatelet therapy (OAT) is a major risk factor for stent thrombosis, myocardial infarction, and cerebral strokes. In order to minimize the risk for thrombotic complications, since 2007 robotic-assisted laparoscopic radical prostatectomy (RARP) has taken place under continuous OAT with aspirin at our institution. In this retrospective study we analyzed the risk for perioperative bleeding and surgical outcome after RARP with OAT. Patients and Methods: All patients who underwent RARP with aspirin OAT at our institution since 2007 were included in this analysis. The OAT group was compared with a group that underwent RARP without OAT, which contained twice the number of patients. Matching of the two groups was performed with regard to the tumor stage and whether a lymph node dissection or nerve-sparing was performed. Results: Thirty-eight patients were assigned to the OAT group and 76 to the control group. A difference in the decrease of postoperative hemoglobin concentration was not detectable between the two groups (mean drop of 2.9 -1.4 g/dL and 2.9 -1.1 g/dL, respectively; P = .93). RARP was completed in all OAT patients without conversion to open surgery. Two of the 38 patients (5.3%) in the OAT group and none in the control group required blood transfusions (P = .11). Equivalent rates of positive surgical margins for pT2 tumors were detected ...

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“…A similar low risk of bleeding in patients with low-dose aspirin medication was observed by Shiffmann et al [46] after endoscopic biopsy or polypectomy, and by Madan et al [30] who conducted a prospective study and performed minor oral surgery in 51 patients without stopping daily low-dose aspirin therapy. When focusing on more invasive operative procedures, like in the topic of prostatectomy [35,50,54] and cardiac surgery [3,8,9,14,20,33,44,45,53], aspirin is a recognized risk factor contributing to excessive peri-operative bleeding and the need for reoperation. Watson et al [54] identified aspirin ingestion, already in 1990, to be a significant etiological factor in post-prostatectomy hemorrhage, and Nielsen et al [35] approved the same statement in a prospective, randomized, double-blind, placebo-controlled study 10 years later.…”

Section: Comparable Surveysmentioning

confidence: 99%

“…When focusing on more invasive operative procedures, like in the topic of prostatectomy [35,50,54] and cardiac surgery [3,8,9,14,20,33,44,45,53], aspirin is a recognized risk factor contributing to excessive peri-operative bleeding and the need for reoperation. Watson et al [54] identified aspirin ingestion, already in 1990, to be a significant etiological factor in post-prostatectomy hemorrhage, and Nielsen et al [35] approved the same statement in a prospective, randomized, double-blind, placebo-controlled study 10 years later. They stated that although there was no significant difference in the median operative blood loss between patients receiving a transurethral prostatectomy either with or without pre-operative aspirin medication, the long-term low-dose ASA therapy is associated with a significant increase in the post-operative blood loss.…”

Section: Comparable Surveysmentioning

confidence: 99%

Low-dose aspirin before spinal surgery: results of a survey among neurosurgeons in Germany

2006

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The main problem faced by the increasing numbers of patients presenting for spinal surgery are receiving concurrent medication with low-dose aspirin, leading to dysfunctional circulating platelets. The contribution of low-dose aspirin to increased peri-operative risk of bleeding and blood loss is a contentious issue with conflicting published results from different surgical groups. Data from neurosurgical spine patients is sparse, but aspirin has been identified as an important risk factor in the development of post-operative hematoma following intracranial surgery. We surveyed the opinions and working practices of the neurosurgical facilities performing spinal operations in Germany regarding patients who present for elective spinal surgery. Identical questionnaires were sent to 210 neurosurgical facilities and proffered five main questions: (1) the adherence of any policy of stopping aspirin pre-operatively, (2) the personal risk assessment for patients with spinal surgery under low-dose aspirin medication, (3) the preferred method of treatment for excessive bleeding in this context, (4) personal knowledge of hemorrhagic complications in this group of patients, and (5) the characteristics of the neurosurgical units concerned. There were 145 (69.1%) responses of which 142 (67.6%) were valid. Of the respondents, 114 (80.3%) had a (written) departmental policy for the discontinuation of pre-operative aspirin treatment, 28 (19.7%) were unaware of such a policy. The mean time suggested for discontinuation of aspirin pre-operatively was 6.9 days (range: 0-21 days), with seven respondents who perform the operations despite the ongoing aspirin medication. Ninety-four respondents (66.2%) considered that patients taking low-dose aspirin were at increased risk for excessive peri-operative hemorrhage or were indetermined (8.6%), and 73 (51.4%) reported having personal experience of such problems. Ninety-two respondents (65.5%) would use special medical therapy, preferably Desmopressin alone or in combination with other blood products or prohemostatic agents (46.1%), if hemorrhagic complications developed intra- or post-operatively. The average number of spinal operations per year in each service was 607.9 (range: 40-1,500). Despite the existence of distinct departmental policies concerning the discontinuation of low-dose aspirin pre-operatively in the majority of neurosurgical facilities performing spinal operations, there is a wide range of the moment of this interruption with an average of 7 days. Two-thirds of the respondents felt that aspirin was a risk factor for hemorrhagic complications associated with spinal procedures, and more than half of the interviewees reported having personal experience of such problems. Finally, various medicamentous methods of counteracting aspirin-induced platelet dysfunction and excessive bleeding in this context are elicited, discussed and evaluated.

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Identifiable Factors in Post‐prostatectomy Haemorrhage: the Role of Aspirin

Cited by 86 publications

References 16 publications

Risk Factors in Prostatectomy Bleeding: Preoperative Urinary Infection is the only Reversible Factor

Risk Factors in Prostatectomy Bleeding: Preoperative Urinary Infection is the only Reversible Factor

Continuous Low-Dose Aspirin Therapy in Robotic-Assisted Laparoscopic Radical Prostatectomy Does Not Increase Risk of Surgical Hemorrhage

Low-dose aspirin before spinal surgery: results of a survey among neurosurgeons in Germany

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