Risks and complications of transurethral resection of bladder tumor among patients taking antiplatelet agents for cardiovascular disease

Picozzi, Stefano; Marenghi, Carlo; Ricci, Cristian; Bozzini, Giorgio; Casellato, Stefano; Carmignani, Luca

doi:10.1007/s00464-013-3136-8

Cited by 16 publications

(19 citation statements)

References 23 publications

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“…The most frequent surgery was related to tooth extraction 22 – 24 and transurethral resection of bladder cancer. 25 Acetylsalicylic acid (ASA) was the common drug in all studies.…”

Section: Resultsmentioning

confidence: 99%

“…In a study performed in the United States, 25 transfusion support was required during four transurethral resection procedures of bladder cancer performed in patients who used antiplatelet therapy in the perioperative period and during two procedures for the control group ( P =0.242). In another study 22 carried out in India, none of the patients subjected to dental extraction had uncontrollable bleeding after the procedure, a result seen both in the group that used interrupted antiplatelet therapy and in the group that had the therapy 5 days before the surgical procedure.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Antiplatelet agents in perioperative noncardiac surgeries: to maintain or to suspend?

Borges¹,

Carvalho²,

Gomes³

et al. 2018

TCRM

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BackgroundWhen prescribing antiplatelet agents, physicians face the challenge of protecting patients from thromboembolic events without inducing bleeding damage. However, especially in the perioperative period, the use of these medications requires a carefully balanced assessment of their risks and benefits.ObjectiveTo conduct a systematic review to check whether the antiplatelet agent is to be maintained or suspended in the perioperative period of noncardiac surgeries.Search strategyA comprehensive literature search using Science Direct, Scopus, MEDLINE-PubMed, and Web of Science was undertaken.Selection criteriaClinical trials of noncardiac surgeries with patients taking regular anti-platelet therapy, published between 2013 and 2018.ResultsA total of 1,302 studies were initially identified, with only four meeting the inclusion criteria. The selected studies were conducted in different countries such as, including India (2), Serbia (1), and the USA (1). The age group was similar in all studies, from 61 to 75 years. The most frequent surgery was related to tooth extraction and transurethral resection of bladder cancer. There was a group of patients who used single antiplatelet agents and groups who used single therapy and double therapy. Acetylsalicylic acid was the common drug in all studies.ConclusionIt was concluded that the clinical trials were classified as good quality and that it was not necessary to suspend antiplatelet therapy prior to surgical procedures such as dental extraction and transurethral resection of bladder cancer. It should be noted that it is necessary to jointly evaluate the type of antiplatelet agent, the thrombotic risk of the patient, and the hemorrhagic risk of the surgical procedure.

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“…The most frequent surgery was related to tooth extraction 22 – 24 and transurethral resection of bladder cancer. 25 Acetylsalicylic acid (ASA) was the common drug in all studies.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Antiplatelet agents in perioperative noncardiac surgeries: to maintain or to suspend?

Borges¹,

Carvalho²,

Gomes³

et al. 2018

TCRM

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“…A PubMed search of “transurethral resection” (of) “bladder” and “morbidity” or “complication”, or “mortality” or “death” yielded 585, 664, 9 and 95 articles, respectively. Of these, 89 articles relevant to the process of defining complexity were analysed, obtaining 36 articles ( Table S1 ) which were instrumental in highlighting adequacy, operative time and morbidity as the three drivers that characterize a complex surgery, as opposed to an uneventful procedure [ 4 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ].…”

Section: Resultsmentioning

confidence: 99%

Consensus Definition and Prediction of Complexity in Transurethral Resection or Bladder Endoscopic Dissection of Bladder Tumours

Roumiguié¹,

Xylinas

Brisuda

et al. 2020

Cancers

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Ten senior urologists were interrogated to develop a predictive model based on factors from which they could anticipate complex transurethral resection of bladder tumours (TURBT). Complexity was defined by consensus. Panel members then used a five-point Likert scale to grade those factors that, in their opinion, drove complexity. Consensual factors were highlighted through two Delphi rounds. Respective contributions to complexity were quantitated by the median values of their scores. Multivariate analysis with complexity as a dependent variable tested their independence in clinical scenarios obtained by random allocation of the factors. The consensus definition of complexity was “any TURBT/En-bloc dissection that results in incomplete resection and/or prolonged surgery (>1 hour) and/or significant (Clavien-Dindo ≥ 3) perioperative complications”. Logistic regression highlighted five domains as independent predictors: patient’s history, tumour number, location, and size and access to the bladder. Receiver operating characteristic (ROC) analysis confirmed good discrimination (AUC = 0.92). The sum of the scores of the five domains adjusted to their regression coefficients or Bladder Complexity Score yielded comparable performance (AUC = 0.91, C-statistics, p = 0.94) and good calibration. As a whole, preoperative factors identified by expert judgement were organized to quantitate the risk of a complex TURBT, a crucial requisite to personalise patient information, adapt human and technical resources to individual situations and address TURBT variability in clinical trials.

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“…Diese ist jedoch nur bei 2 % der Patienten erforderlich [16]. Die Transfusionsrate nach TUR-Blase ist entsprechend niedrig bei 3 % [16,17].…”

Section: Blutungenunclassified

“…Ein Absetzen des Medikamentes müsste also mindestens eine 7-tägige Zeitspanne vorher umfassen. Picozzi et al untersuch-ten, ob die Einnahme von ASS bei der TUR-Blase zu einer erhöhten Blutungskomplikation führt und konnten zeigen, dass die Monotherapie mittels ASS weder zu einer Erhöhung der perioperativen Blutungskomplikationen, noch zu einer erhöhten postoperativen Notwendigkeit einer Reintervention aufgrund von Blutungsereignissen führt [17]. Eine Arbeit von Wenders et al zeigt zwar tendenziell erhöhte Blutungskomplikationen und häufigere operative Revisionen in der Gruppe der Patienten, die perioperativ ASS einnahmen, jedoch war der Unterschied statistisch nicht signifikant (Postoperative Blutung mit ASS 18,7 % vs. ohne ASS 8,6 % (p = 0,115), Revisionsnotwendigkeit 6,3 % vs. 3,4 % (p = 0,61) [18].…”

Section: Blutungenunclassified

Komplikationsmanagement bei der TUR-Blase

Mally

Paffenholz

2020

Aktuelle Urol

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ZusammenfassungDie transurethrale Resektion der Harnblase (TUR-Blase) ist ein Standardeingriff der operativen Urologie. Eine komplette Resektion steht hierbei an höchster Stelle. Darüber hinaus ist die Kenntnis der möglichen Komplikationen und das dazugehörige Komplikationsmanagement für die klinische Praxis essenziell. Zu den häufigsten Komplikationen gehören katheterassoziierte Beschwerden, Blutungen, Infektionen und die Harnblasenperforation. Doch auch die Resektion des Harnleiterostiums und Lagerungsschäden stellen zwar seltenere, aber dennoch unmittelbar behandlungswürdige Komplikationen dar. In der vorliegenden Übersichtsarbeit werden diese Komplikationen zusammengefasst sowie deren Vorbeugung und Management vorgestellt.

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Risks and complications of transurethral resection of bladder tumor among patients taking antiplatelet agents for cardiovascular disease

Abstract: The current results suggest that continued use of anti-aggregant monotherapy does not increase the risk of overall bleeding or reintervention for patients undergoing transurethral resection of bladder neoplasms and that suspending aspirin before such a procedure is therefore unnecessary.

Cited by 16 publications

References 23 publications

Antiplatelet agents in perioperative noncardiac surgeries: to maintain or to suspend?

Antiplatelet agents in perioperative noncardiac surgeries: to maintain or to suspend?

Consensus Definition and Prediction of Complexity in Transurethral Resection or Bladder Endoscopic Dissection of Bladder Tumours

Komplikationsmanagement bei der TUR-Blase

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