Perioperative aspirin use during robotic partial nephrectomy tied to bleeding complications

Use of perioperative aspirin 81 mg during robotic partial nephrectomy (RPN) is reasonable and safe in experienced hands, but there remains an increased risk of blood transfusions and major complications, suggests a recent study.

Previous studies in single institutions have examined perioperative outcomes of aspirin use in RPN. In this study, the investigators aimed to assess outcomes of perioperative aspirin use during RPN in a multicentre setting.

A retrospective analysis was conducted on patients undergoing RPN at five high-volume RPN institutions. The investigators compared perioperative outcomes of participants taking aspirin 81 mg with those not on aspirin. Then, they analysed the association between perioperative aspirin use and perioperative transfusion.

A total of 1,565 patients underwent RPN, of whom 228 (14.5 percent) continued perioperative aspirin use. These patients were older (62.8 vs 56.8 years; p<0.001) and had higher Charlson scores (mean 3 vs 2; p<0.001) than those not taking aspirin.

Aspirin use correlated with more perioperative blood transfusions (11 percent vs 4 percent; p<0.001) and major complications (10 percent vs 3 percent; p<0.001). Multivariable analysis also revealed an association between perioperative aspirin use and increased risk of transfusion (odds ratio, 1.94, 95 percent confidence interval, 1.10‒3.45).

Further research is warranted to shed light on the role of antiplatelet therapy in RPN patients requiring perioperative aspirin for primary or secondary prevention of cardiovascular events.

“Daily aspirin use following cardiovascular intervention is commonplace and creates concern regarding bleeding risk in patients undergoing surgery,” the investigators said. “Despite its cardioprotective role, aspirin is often discontinued 5–7 days prior to major surgery due to bleeding concerns.”