Oncology - Bladder, Renal, Test
Mid-Atlantic Section 76th Annual Meeting
Introduction & Objective : There is little procedure-specific data to guide the perioperative management of antiplatelet and anticoagulant medications in patients undergoing transurethral resection of bladder tumors (TURBT). We sought to determine the association between these medications and complications after TURBT
Methods : We retrospectively reviewed the charts of 116 patients at the Hospital of the University of Pennsylvania who underwent their first TURBT between January 2016 and June 2017. Antiplatelet and anticoagulant medication was previously prospectively documented, including whether and for how long these were held perioperatively. Specific categories of these included aspirin, novel antiplatelet agents (only clopidogrel in our cohort), anticoagulants, omega-3 supplements, and non-steroidal anti-inflammatory drugs. Additional retrospectively collected exposure variables included patient age, sex, surgeon, size of tumor on imaging, mitomycin administration, and final tumor stage. Our primary outcome was adverse events (AEs), a composite of unplanned postoperative admission, emergency department (ED) presentation, and return to the operating room.
Results : 27 (23.2%) patients suffered AEs, including 11 postoperative admissions, 18 ED presentations, and 2 returns to the operating room. There were no thromboembolic or cardiac events. All ED presentations were prompted by hematuria, suprapubic pain, catheter problems, and/or urinary retention. The median date of ED representation was 3 days postoperatively (interquartile range 1-4.25). All anticoagulants and clopidogrel were paused perioperatively. Nevertheless, patients taking anticoagulants were significantly more likely to suffer AEs (odds ratio (OR) 4.0, 95% confidence interval (CI) 1.2-3.7). Multivariate logistic regression similarly yielded anticoagulation as the exposure most closely associated with AEs, although this narrowly failed to reach statistical significance (p=0.064). No significant difference in adverse events was detected in patients taking clopidogrel, NSAIDs, omega-3 supplements or aspirin even if the last of these was not paused perioperatively.
Conclusions : Anticoagulation but not antiplatelet therapy was significantly associated with adverse events after TURBT.