Antikoagülan Ve Antiagregan İlaç Kullanan Hastalarda Radikal Sistektomi ve Radikal Prostatektomi Operasyonu: Preop Hasta Hazırlık ve Postop Takip Süreci
Özet
Ürolojik hastaların çoğu tıbbi komorbiditelere sahiptir. Ürologlar sıklıkla atriyal fibrilasyon, mekanik kalp kapakçıkları veya koroner arter hastalığının tedavisi için antikoagülan veya antiplatelet tedavisi gören hastalarla karşılaşırlar. Bu tedavilerin kesilmesini içeren perioperatif yönetim dönemi zorlu ve komplikasyonlara açık olabilir. Protez kapaklar, atriyal fibrilasyon ve koroner arter stentleri gibi belirli tıbbi durumların tedavisi için kullanılan antikoagülan ve antiplatelet ajanların ameliyat öncesi yönetimi, dahiliye uzmanı veya kardiyolog ile birlikte yapılmalıdır. Elektif ürolojik cerrahinin metal stentler için en az 30 gün, ilaç salınımlı stentler içinse mümkünse 1 yıldan daha uzun süre ertelenmesi önerilmiştir. Ancak onkolojik prosedürlere göre bu durum değerlendirilmelidir. Radikal prostatektomi ve radikal sistektomi ürolojinin yüksek kanama riski olan ve elektif olarak değerlendirilmeyen prosedürleridir. Radikal prostatektomi ve radikal sistektomide mevcut bilimsel kanıtlar, arteriyel tromboz gelişme riski daha yüksek olan hastalarda perioperatif antiplatelet tedavinin sürdürülmesi olasılığını ortaya koymaktadır, çünkü faydaları kanama riskinden daha ağır basmaktadır. Özellikle minimal invaziv cerrahinin gelişmesi ile birlikte antiplatelet tedavi devam ederken opere edilen hastalarda intraoperatif ve postoperatif komplikasyonlarda artış görülmemiştir. Antikoagülan tedavide ise düşük molekül ağırlıklı heparin ile köprüleme tedavisi kullanılmasına rağmen doz bağımlı olarak kanama komplikasyonlarının dikkatle izlenmesi gerekmektedir. Cerrahi sonrası dönemde ise dördüncü günde kanama komplikasyonu olasılığının oldukça azalmasından dolayı eğer antiplatelet veya antikoagülan tedavi kesilmişse başlanabileceği önerisi yapılmıştır.
Most urologic patients have medical comorbidities. Urologists often encounter patients on anticoagulant or antiplatelet therapy for the treatment of atrial fibrillation, mechanical heart valves or coronary artery disease. The perioperative management period, including discontinuation of these therapies, can be challenging and prone to complications. Preoperative management of anticoagulants and antiplatelet agents used for the treatment of certain medical conditions, such as prosthetic valves, atrial fibrillation and coronary artery stents, should be done in conjunction with an internist or cardiologist. It has been recommended to postpone elective urologic surgery for at least 30 days for metal stents and longer than 1 year for drug-eluting stents, if possible. However, this should be evaluated according to oncologic procedures. Radical prostatectomy and radical cystectomy are procedures in urology that have a high bleeding risk and are not considered elective. In radical prostatectomy and radical cystectomy, available scientific evidence suggests the possibility of continuing perioperative antiplatelet therapy in patients at higher risk of developing arterial thrombosis because the benefits outweigh the risk of bleeding. Especially with the development of minimally invasive surgery, there has been no increase in intraoperative and postoperative complications in patients operated on while continuing antiplatelet therapy. In anticoagulant therapy, although bridging therapy with low molecular weight heparin is used, dose-dependent bleeding complications should be carefully monitored. In the postoperative period, it has been suggested that antiplatelet or anticoagulant therapy can be started if antiplatelet or anticoagulant therapy has been discontinued, since the likelihood of bleeding complications is considerably reduced on the fourth postoperative day.
Referanslar
Otto SJ, Schröder FH, de Koning HJ. Risk of cardiovascular mortality in prostate cancer patients in the Rotterdam randomized screening trial. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2006; 24(25):4184-9.
Douketis JD, Spyropoulos AC, Spencer FA, Mayr M, Jaffer AK, Eckman MH, et al. Perioperative management of antithrombotic therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141(2 Suppl):e326S-e50S.
O'Riordan JM, Margey RJ, Blake G, O'Connell PR. Antiplatelet agents in the perioperative period. Archives of surgery (Chicago, Ill : 1960) 2009; 144(1):69-76; discussion
Gupta AD, Streiff M, Resar J, Schoenberg M. Coronary stent management in elective genitourinary surgery. BJU international 2012; 110(4):480-4.
Cutlip DE, Baim DS, Ho KK, Popma JJ, Lansky AJ, Cohen DJ, et al. Stent thrombosis in the modern era: a pooled analysis of multicenter coronary stent clinical trials. Circulation 2001; 103(15):1967-71.
Roehl KA, Han M, Ramos CG, Antenor JA, Catalona WJ. Cancer progression and survival rates following anatomical radical retropubic prostatectomy in 3,478 consecutive patients: long-term results. The Journal of urology 2004; 172(3):910-4.
Dotan ZA, Mor Y, Leibovitch I, Varon D, Golomb J, Duvdevani M, et al. The efficacy and safety of perioperative low molecular weight heparin substitution in patients on chronic oral anticoagulant therapy undergoing transurethral prostatectomy for bladder outlet obstruction. The Journal of urology 2002; 168(2):610-3; discussion 4.
Varkarakis IM, Rais-Bahrami S, Allaf ME, Lima GC, Permpongkosol S, Rao P, et al. Laparoscopic renal-adrenal surgery in patients on oral anticoagulant therapy. The Journal of urology 2005; 174(3):1020-3; discussion 3.
Enver MK, Hoh I, Chinegwundoh FI. The management of aspirin in transurethral prostatectomy: current practice in the UK. Annals of the Royal College of Surgeons of England 2006; 88(3):280-3.
Berger JS, Roncaglioni MC, Avanzini F, Pangrazzi I, Tognoni G, Brown DL. Aspirin for the primary prevention of cardiovascular events in women and men: a sex-specific meta-analysis of randomized controlled trials. Jama 2006; 295(3):306-13.
Binhas M, Salomon L, Roudot-Thoraval F, Armand C, Plaud B, Marty J. Radical prostatectomy with robot-assisted radical prostatectomy and laparoscopic radical prostatectomy under low-dose aspirin does not significantly increase blood loss. Urology 2012; 79(3):591-5.
Krane LS, Laungani R, Satyanarayana R, Kaul S, Bhandari M, Peabody JO, et al. Robotic-assisted radical prostatectomy in patients receiving chronic anticoagulation therapy: role of perioperative bridging. Urology 2008; 72(6):1351-5.
Parikh A, Toepfer N, Baylor K, Henry Y, Berger P, Rukstalis D. Preoperative aspirin is safe in patients undergoing urologic robot-assisted surgery. Journal of endourology 2012; 26(7):852-6.
Schmitges J, Trinh QD, Jonas L, Budäus L, Larbig R, Schlomm T, et al. Influence of low-molecular-weight heparin dosage on red blood cell transfusion, lymphocele rate and drainage duration after open radical prostatectomy. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 2012; 38(11):1082-8.
Finkelstein J, Eckersberger E, Sadri H, Taneja SS, Lepor H, Djavan B. Open Versus Laparoscopic Versus Robot-Assisted Laparoscopic Prostatectomy: The European and US Experience. Reviews in urology 2010; 12(1):35-43.
Watson CJ, Deane AM, Doyle PT, Bullock KN. Identifiable factors in post-prostatectomy haemorrhage: the role of aspirin. British journal of urology 1990; 66(1):85-7.
Oshima M, Washino S, Nakamura Y, Konishi T, Saito K, Arai Y, et al. Risks and complications of robot-assisted radical prostatectomy (RARP) in patients receiving antiplatelet and/or anticoagulant therapy: a retrospective cohort study in a single institute. Journal of robotic surgery 2021; 15(4):661-70.
Kubota M, Matsuoka T, Yamasaki T, Kokubun H, Hagimoto H, Murata S, et al. Effect of Continued Perioperative Anticoagulant Therapy on Bleeding Outcomes Following Robot-assisted Radical Prostatectomy. Urology 2021; 148:151-8.
Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al. Executive summary: heart disease and stroke statistics--2014 update: a report from the American Heart Association. Circulation 2014; 129(3):399-410.
Hornor MA, Duane TM, Ehlers AP, Jensen EH, Brown PS, Jr., Pohl D, et al. American College of Surgeons' Guidelines for the Perioperative Management of Antithrombotic Medication. Journal of the American College of Surgeons 2018; 227(5):521-36.e1.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA: A Cancer Journal for Clinicians 2019; 69(1):7-34.
Bagrodia A, Sukhu R, Winer AG, Levy E, Vacchio M, Lee B, et al. Incidence and Effect of Thromboembolic Events in Radical Cystectomy Patients Undergoing Preoperative Chemotherapy for Muscle-invasive Bladder Cancer. Clinical genitourinary cancer 2018; 16(1):e113-e20.
Browne C, Davis NF, Nolan WJ, MacCraith ED, Lennon GM, Mulvin DW, et al. Neoadjuvant Platinum-Based Chemotherapy is an Independent Predictor for Preoperative Thromboembolic Events in Bladder Cancer Patients Undergoing Radical Cystectomy. Current urology 2017; 10(3):132-5.
Bagrodia A, Sukhu R, Winer AG, Levy E, Vacchio M, Lee B, et al. Incidence and Effect of Thromboembolic Events in Radical Cystectomy Patients Undergoing Preoperative Chemotherapy for Muscle-invasive Bladder Cancer. Clinical genitourinary cancer 2017;
Doherty JU, Gluckman TJ, Hucker WJ, Januzzi JL, Ortel TL, Saxonhouse SJ, et al. 2017 ACC Expert Consensus Decision Pathway for Periprocedural Management of Anticoagulation in Patients With Nonvalvular Atrial Fibrillation: A Report of the American College of Cardiology Clinical Expert Consensus Document Task Force. Journal of the American College of Cardiology 2017; 69(7):871-98.
Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, et al. 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery. Circulation 2014; 130(24):e278-e333.
Douketis JD, Spyropoulos AC, Kaatz S, Becker RC, Caprini JA, Dunn AS, et al. Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation. New England Journal of Medicine 2015; 373(9):823-33.
Wessels F, Kriegmair MC, Oehme A, Rassweiler-Seyfried MC, Erben P, Oberneder R, et al. Radical cystectomy under continuous antiplatelet therapy with acetylsalicylic acid. European Journal of Surgical Oncology 2019; 45(7):1260-5.
Smelser WW, Jones CP. Management of anticoagulation and antiplatelet agents in the radical cystectomy patient. Urologic oncology 2021; 39(10):691-7.
Tikkinen KA, Agarwal A, Craigie S, Cartwright R, Gould MK, Haukka J, et al. Systematic reviews of observational studies of risk of thrombosis and bleeding in urological surgery (ROTBUS): introduction and methodology. Systematic reviews 2014; 3:150.
Amin AN, Lenhart G, Princic N, Lin J, Thompson S, Johnston S. Retrospective administrative database study of the time period of venous thromboembolism risk during and following hospitalization for major orthopedic or abdominal surgery in real-world US patients. Hospital practice (1995) 2011; 39(2):7-17.
Referanslar
Otto SJ, Schröder FH, de Koning HJ. Risk of cardiovascular mortality in prostate cancer patients in the Rotterdam randomized screening trial. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2006; 24(25):4184-9.
Douketis JD, Spyropoulos AC, Spencer FA, Mayr M, Jaffer AK, Eckman MH, et al. Perioperative management of antithrombotic therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141(2 Suppl):e326S-e50S.
O'Riordan JM, Margey RJ, Blake G, O'Connell PR. Antiplatelet agents in the perioperative period. Archives of surgery (Chicago, Ill : 1960) 2009; 144(1):69-76; discussion
Gupta AD, Streiff M, Resar J, Schoenberg M. Coronary stent management in elective genitourinary surgery. BJU international 2012; 110(4):480-4.
Cutlip DE, Baim DS, Ho KK, Popma JJ, Lansky AJ, Cohen DJ, et al. Stent thrombosis in the modern era: a pooled analysis of multicenter coronary stent clinical trials. Circulation 2001; 103(15):1967-71.
Roehl KA, Han M, Ramos CG, Antenor JA, Catalona WJ. Cancer progression and survival rates following anatomical radical retropubic prostatectomy in 3,478 consecutive patients: long-term results. The Journal of urology 2004; 172(3):910-4.
Dotan ZA, Mor Y, Leibovitch I, Varon D, Golomb J, Duvdevani M, et al. The efficacy and safety of perioperative low molecular weight heparin substitution in patients on chronic oral anticoagulant therapy undergoing transurethral prostatectomy for bladder outlet obstruction. The Journal of urology 2002; 168(2):610-3; discussion 4.
Varkarakis IM, Rais-Bahrami S, Allaf ME, Lima GC, Permpongkosol S, Rao P, et al. Laparoscopic renal-adrenal surgery in patients on oral anticoagulant therapy. The Journal of urology 2005; 174(3):1020-3; discussion 3.
Enver MK, Hoh I, Chinegwundoh FI. The management of aspirin in transurethral prostatectomy: current practice in the UK. Annals of the Royal College of Surgeons of England 2006; 88(3):280-3.
Berger JS, Roncaglioni MC, Avanzini F, Pangrazzi I, Tognoni G, Brown DL. Aspirin for the primary prevention of cardiovascular events in women and men: a sex-specific meta-analysis of randomized controlled trials. Jama 2006; 295(3):306-13.
Binhas M, Salomon L, Roudot-Thoraval F, Armand C, Plaud B, Marty J. Radical prostatectomy with robot-assisted radical prostatectomy and laparoscopic radical prostatectomy under low-dose aspirin does not significantly increase blood loss. Urology 2012; 79(3):591-5.
Krane LS, Laungani R, Satyanarayana R, Kaul S, Bhandari M, Peabody JO, et al. Robotic-assisted radical prostatectomy in patients receiving chronic anticoagulation therapy: role of perioperative bridging. Urology 2008; 72(6):1351-5.
Parikh A, Toepfer N, Baylor K, Henry Y, Berger P, Rukstalis D. Preoperative aspirin is safe in patients undergoing urologic robot-assisted surgery. Journal of endourology 2012; 26(7):852-6.
Schmitges J, Trinh QD, Jonas L, Budäus L, Larbig R, Schlomm T, et al. Influence of low-molecular-weight heparin dosage on red blood cell transfusion, lymphocele rate and drainage duration after open radical prostatectomy. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 2012; 38(11):1082-8.
Finkelstein J, Eckersberger E, Sadri H, Taneja SS, Lepor H, Djavan B. Open Versus Laparoscopic Versus Robot-Assisted Laparoscopic Prostatectomy: The European and US Experience. Reviews in urology 2010; 12(1):35-43.
Watson CJ, Deane AM, Doyle PT, Bullock KN. Identifiable factors in post-prostatectomy haemorrhage: the role of aspirin. British journal of urology 1990; 66(1):85-7.
Oshima M, Washino S, Nakamura Y, Konishi T, Saito K, Arai Y, et al. Risks and complications of robot-assisted radical prostatectomy (RARP) in patients receiving antiplatelet and/or anticoagulant therapy: a retrospective cohort study in a single institute. Journal of robotic surgery 2021; 15(4):661-70.
Kubota M, Matsuoka T, Yamasaki T, Kokubun H, Hagimoto H, Murata S, et al. Effect of Continued Perioperative Anticoagulant Therapy on Bleeding Outcomes Following Robot-assisted Radical Prostatectomy. Urology 2021; 148:151-8.
Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al. Executive summary: heart disease and stroke statistics--2014 update: a report from the American Heart Association. Circulation 2014; 129(3):399-410.
Hornor MA, Duane TM, Ehlers AP, Jensen EH, Brown PS, Jr., Pohl D, et al. American College of Surgeons' Guidelines for the Perioperative Management of Antithrombotic Medication. Journal of the American College of Surgeons 2018; 227(5):521-36.e1.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA: A Cancer Journal for Clinicians 2019; 69(1):7-34.
Bagrodia A, Sukhu R, Winer AG, Levy E, Vacchio M, Lee B, et al. Incidence and Effect of Thromboembolic Events in Radical Cystectomy Patients Undergoing Preoperative Chemotherapy for Muscle-invasive Bladder Cancer. Clinical genitourinary cancer 2018; 16(1):e113-e20.
Browne C, Davis NF, Nolan WJ, MacCraith ED, Lennon GM, Mulvin DW, et al. Neoadjuvant Platinum-Based Chemotherapy is an Independent Predictor for Preoperative Thromboembolic Events in Bladder Cancer Patients Undergoing Radical Cystectomy. Current urology 2017; 10(3):132-5.
Bagrodia A, Sukhu R, Winer AG, Levy E, Vacchio M, Lee B, et al. Incidence and Effect of Thromboembolic Events in Radical Cystectomy Patients Undergoing Preoperative Chemotherapy for Muscle-invasive Bladder Cancer. Clinical genitourinary cancer 2017;
Doherty JU, Gluckman TJ, Hucker WJ, Januzzi JL, Ortel TL, Saxonhouse SJ, et al. 2017 ACC Expert Consensus Decision Pathway for Periprocedural Management of Anticoagulation in Patients With Nonvalvular Atrial Fibrillation: A Report of the American College of Cardiology Clinical Expert Consensus Document Task Force. Journal of the American College of Cardiology 2017; 69(7):871-98.
Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, et al. 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery. Circulation 2014; 130(24):e278-e333.
Douketis JD, Spyropoulos AC, Kaatz S, Becker RC, Caprini JA, Dunn AS, et al. Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation. New England Journal of Medicine 2015; 373(9):823-33.
Wessels F, Kriegmair MC, Oehme A, Rassweiler-Seyfried MC, Erben P, Oberneder R, et al. Radical cystectomy under continuous antiplatelet therapy with acetylsalicylic acid. European Journal of Surgical Oncology 2019; 45(7):1260-5.
Smelser WW, Jones CP. Management of anticoagulation and antiplatelet agents in the radical cystectomy patient. Urologic oncology 2021; 39(10):691-7.
Tikkinen KA, Agarwal A, Craigie S, Cartwright R, Gould MK, Haukka J, et al. Systematic reviews of observational studies of risk of thrombosis and bleeding in urological surgery (ROTBUS): introduction and methodology. Systematic reviews 2014; 3:150.
Amin AN, Lenhart G, Princic N, Lin J, Thompson S, Johnston S. Retrospective administrative database study of the time period of venous thromboembolism risk during and following hospitalization for major orthopedic or abdominal surgery in real-world US patients. Hospital practice (1995) 2011; 39(2):7-17.
