Aspirin and clopidogrel during robotic partial nephrectomy, is it safe?

Area of Science:

• Urology
• Cardiovascular Surgery
• Oncology

Background:

• Continuing antiplatelet medications during major urologic surgery poses bleeding risks.
• Withdrawing antiplatelet therapy can lead to severe cardiovascular complications.
• Robotic partial nephrectomy (RPN) is a complex procedure requiring careful perioperative management.

Purpose of the Study:

• To assess the feasibility and safety of performing RPN in patients maintained on aspirin or dual antiplatelet therapy (aspirin and clopidogrel).

Main Methods:

• Prospective data collection on 230 patients undergoing RPN.
• Analysis of a subgroup of patients who continued aspirin or aspirin and clopidogrel perioperatively.
• Evaluation of intraoperative and postoperative outcomes.

Main Results:

• Six patients continued antiplatelet therapy (4 on aspirin, 2 on aspirin and clopidogrel).
• Average RENAL score was 7, mean tumor size 4.1 cm.
• No intraoperative complications or conversions to open surgery; 33% 90-day complication rate with one late bleed after coumadin initiation.

Conclusions:

• RPN can be safely performed in select patients maintained on aspirin and clopidogrel.
• This study is the first to report on RPN outcomes in patients on dual antiplatelet therapy.
• Careful patient selection is crucial for managing antiplatelet therapy during RPN.