Presentation Authors: Kevin Hebert*, David Yang, Kevin Wymer, Landon Trost, Tobias Kohler, Rochester, MN
Introduction: Patients with medically refractory erectile dysfunction (ED) frequently have cardiovascular risk factors requiring antithrombotics (anticoagulation and/or antiplatelets) at the time of inflatable penile prosthesis (IPP) surgery. Discontinuation of antithrombotics prior to surgery is associated with increased myocardial infarction and cerebrovascular accident risk. Limited data are available on perioperative morbidity associated with continuation of antithrombotics at time of IPP placement. We sought to evaluate the outcomes of continuation of antithrombotics at time of IPP surgery.
Methods: We retrospectively reviewed clinical and operative records of men undergoing IPP placement at our institution. In this series, the device was left inflated at 60-80% and a mummy wrap was performed. Detailed information was obtained related to perioperative antithrombotic management and postoperative outcomes. Statistical analysis was performed to evaluate for differences in scrotal drain output, hematoma formation rate, and post-operative morbidity among patients who continued versus held antithrombotics.
Results: 70 patients (mean age 65 years) underwent IPP placement at our institution from July 2017 through May 2018. Of these men, 40 (57%) reported baseline use of antithrombotics and make up the current study cohort. Twenty-seven of the 40 (68%) continued antithrombotics through IPP placement, including aspirin 81mg (n=20), aspirin 325mg (n=3), clopidogrel(N=2), apixaban (N=3), warfarin (N=5), and combination therapy (N=6). On univariate analysis, no statistically significant difference in post-operative day zero drain output was identified between patients who continued versus held antithrombotics at the time of surgery (72.6 mL vs 73.4 mL; p=0.94). Three patients (4%), developed self-resolving hematomas at 6 week follow up. Of these three patients, one was not on antithrombotics at baseline, one continued aspirin 81mg and held Xarelto, and one continued aspirin 81mg. No difference in hematoma formation was identified in patients who continued on aspirin, apixaban, clopidogrel, warfarin, or combination therapy compared to patients off of antithrombotics (all p>0.05). 13 of 40 patients (32%) held antithrombotics at time of surgery with 2 of 13 (15%) experiencing a post-operative cardiovascular event.
Conclusions: In a small operative series, continuing antithrombotics at the time of IPP placement did not result in statistically higher scrotal drain output or rate of hematomas compared to those who held antithrombotics. Given the potential complications of holding antithrombotics in a high-risk population, these data suggest a practice of continuing antithrombotics at the time of IPP surgery and require further validation.