Perioperative continuation of aspirin, oral anticoagulants or bridging with therapeutic low-molecular weight heparin does not increase intraoperative blood loss and blood transfusion rate in cystectomy patients: An observational cohort study.

Abstract

OBJECTIVE\nTo assess if uninterrupted anticoagulant agents administration affects blood loss and blood transfusion during open radical cystectomy and urinary diversion.\n\n\nMATERIAL AND METHODS\nWe conducted an observational single-centre cohort study of a consecutive series of 1430 cystectomy patients, between 2000 and 2020. Blood loss was depicted according to body weight and duration of surgery (ml/kg/h), and blood transfusion. Group with anticoagulant agents was considered if surgery was performed with uninterrupted low-dose aspirin (ASS), oral anticoagulants (OAC) with international normalized ratio (INR) goal of 2-2.5, or bridging with therapeutic low weight molecular heparin (LMWH). Outcomes were intraoperative blood loss, blood transfusion rate (separately analysed if administered within 24 h perioperatively or >24 h after surgery) and the 90d major adverse cardiac events (MACE) rate. We used propensity score (PS) matching analysis to adjust for imbalances between groups with or without anticoagulant agents.\n\n\nRESULTS\nPS-matched median blood loss was 2.10 ml/kg/h [interquartile range (IQR) 1.50-2.94] in patients with anticoagulant agents vs. 2.11 ml/kg/h without anticoagulant agents [IQR: 1.47-2.94]; Padj >0.99. PS-matched blood transfusion rates were 26.2% vs. 35.1% (Padj =0.875) within 24 h perioperatively and 57.0% vs. 55.0% (Padj =0.680) if administered >24 h postoperatively. A sub-analysis of the three different anticoagulant agents could not detect any significance between ASS, OAC, or LMWH. The PS-matched incidence of MACE was 9.1% in the group with anticoagulant agents and 8.1% in those without anticoagulant agents; Padj >0.99. Limitations include selection bias and retrospective analysis from prospectively assessed data.\n\n\nCONCLUSIONS\nPerioperative continuation of ASS, uninterrupted OAC with low INR goal or bridging with LMWH had no impact on blood loss and transfusion rate in cystectomy patients. Therefore, there might be no compulsive need for discontinuation of anticoagulant agents.