Perioperative anticoagulation post robot-assisted radical prostatectomy not associated with increased high-grade bleeding risk

1. Patients continuing perioperative anticoagulation when undergoing robot-assisted radical prostatectomy did not experience an increased incidence of high-grade bleeding.

Evidence Level Rating: 2 (Good)

Robot-assisted radical prostatectomy (RARP) is the standard of care for surgical management of localized prostate cancer. As RARP is classified as a hemorrhagic procedure, patients on anticoagulation who have a high risk of thromboembolic complications are generally asked to stop anticoagulation and/or receive bridging therapy with heparin derivatives. The purpose of this retrospective study was to assess the impact of continuing perioperative anticoagulation administration in patients undergoing RARP. The primary outcome was the incidence of 90-day bleeding complications requiring transfusion, additional intervention, or readmission. 606 patients were included for analysis and followed until 90 days postoperatively. Among them, 105 continued anticoagulation, including 31 patients taking warfarin or direct oral anticoagulants (anticoagulation cohort), 13 patients taking clopidogrel or prasugrel (thienopyridine cohort), and 61 patients taking aspirin (aspirin cohort). It was found that the incidence of bleeding complications was not significantly different between the anticoagulation cohort and the thienopyridine, aspirin, and control cohorts (3% vs. 8% [p = 0.51]; 0% [p = 0.34]; and 0.4% [p = 0.17], respectively). Importantly, no patients in any cohort required secondary interventions to control postoperative bleeding. Furthermore, there was no significant difference between the anticoagulation cohort and the thienopyridine, aspirin, and control cohorts with regards to the incidence of thromboembolic complications (3% vs. 0% [p = 0.70]; 2% [p = 0.56]; and 0.2% [p = 0.11], respectively). Overall, this study suggests that continuing perioperative use of anticoagulation in patients undergoing RARP is safe and does not increase the risk of high-grade bleeding complications. Further verification of these findings with randomized studies, however, is warranted.

Click to read the study in Urology

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