INTRODUCTION: Transurethral resection of bladder tumor (TURBT) is considered to be at a moderate or high risk of bleeding during surgical procedure. The number of patients on antiplatelet (AP) drugs has been increasing; we wanted to assess their impact on the outcome of patients undergoing scheduled TURBT. MATERIALS AND METHODS: A retrospective assessment of noninferiority of 450 consecutive procedures performed between April 2013 and June 2015 was conducted. Patients were divided in two groups: naive or AP drug users. The primary endpoint was the average length of stay (ALOS). Noninferiority was set at 1 day. A subgroup analysis comparing the acetylsalicylic acid (ASA) group and clopidogrel group to the naive group was performed. Multivariate analysis was performed to find the determinants of a longer ALOS. Chi-square or Fisher tests were used to analyze categorical variables, and Student's or Mann-Whitney tests were used to analyze quantitative variables. RESULTS: We included 325 patients who underwent TURBT: 117 received AP drugs (ASA, 85; clopidogrel, 32) and 208 were naive to AP drugs (of whom 117 were consecutively analyzed). The ALOSs were 2.5 days (naive group) and 2.9 days (AP group). The subgroup analysis showed ALOSs of 2.6 days (ASA group) and 3.7 days (clopidogrel group). Clopidogrel therapy (odds ratio = 4.1 [1.7-9.6]) and the duration and depth of resection emerged as determinants of a longer ALOS in multivariate analysis. Perioperative management of AP therapies was achieved according to recommended practices. CONCLUSIONS: The ALOS of patients receiving AP drugs was not clinically different from naive patients. This result was identical for patients receiving ASA. However, clopidogrel increased the length of stay, making us question its use in perioperative management.
INTRODUCTION: Transurethral resection of bladder tumor (TURBT) is considered to be at a moderate or high risk of bleeding during surgical procedure. The number of patients on antiplatelet (AP) drugs has been increasing; we wanted to assess their impact on the outcome of patients undergoing scheduled TURBT. MATERIALS AND METHODS: A retrospective assessment of noninferiority of 450 consecutive procedures performed between April 2013 and June 2015 was conducted. Patients were divided in two groups: naive or AP drug users. The primary endpoint was the average length of stay (ALOS). Noninferiority was set at 1 day. A subgroup analysis comparing the acetylsalicylic acid (ASA) group and clopidogrel group to the naive group was performed. Multivariate analysis was performed to find the determinants of a longer ALOS. Chi-square or Fisher tests were used to analyze categorical variables, and Student's or Mann-Whitney tests were used to analyze quantitative variables. RESULTS: We included 325 patients who underwent TURBT: 117 received AP drugs (ASA, 85; clopidogrel, 32) and 208 were naive to AP drugs (of whom 117 were consecutively analyzed). The ALOSs were 2.5 days (naive group) and 2.9 days (AP group). The subgroup analysis showed ALOSs of 2.6 days (ASA group) and 3.7 days (clopidogrel group). Clopidogrel therapy (odds ratio = 4.1 [1.7-9.6]) and the duration and depth of resection emerged as determinants of a longer ALOS in multivariate analysis. Perioperative management of AP therapies was achieved according to recommended practices. CONCLUSIONS: The ALOS of patients receiving AP drugs was not clinically different from naive patients. This result was identical for patients receiving ASA. However, clopidogrel increased the length of stay, making us question its use in perioperative management.
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Keywords:
TURBT; antiaggregant; antiplatelet; aspirin; bladder cancer