Skip to main content

Advertisement

SpringerLink
Log in

Endoscopic resection of bladder cancer in patients receiving double platelet antiaggregant therapy

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Approximately 5% of patients who have undergone coronary artery stenting require noncardiac surgery within a year of their cardiac intervention. European cardiological guidelines and recommendations from the U.S. Food and Drug Administration on platelet antiaggregant therapy following coronary artery stenting are for dual treatment with acetylsalicylic acid and clopidogrel, which should be continued for at least 12 months. The aim of this study was to evaluate the clinical course in patients receiving double platelet antiaggregant therapy who underwent transurethral resection of bladder cancer.

Methods

Between September 2007 and April 2010, twelve patients receiving double antithrombotic therapy (clopidogrel + acetylsalicylic acid) underwent transurethral resection of bladder cancer. In two cases the operation was “urgent”. The mean age of the patients was 71.25 years (range, 52–83 years). In nine cases the bladder cancer was newly diagnosed.

Results

The patients’ preoperative mean hemoglobin concentration was 11.4 g/dl (range = 5.2–13.4 g/dl), and on the first postoperative day it was 10.2 g/dl (range = 9.6–12.6 g/dl). The mean duration of the intervention was 32 min (range = 20–60 min). There were no cardiac complications in either the perioperative or the postoperative period. No patient required reintervention for hemostatic purposes. Three episodes of clot-related acute urinary retention occurred after removal of the bladder catheter, all of which were resolved with replacement of the catheter without needing reintervention.

Conclusion

Despite the high number of complications related to cardiac problems that suspension of these drugs causes, this urological intervention, carried out during dual antithrombotic therapy, was feasible and without major complications. Given the high proportion of complications due to clot-related urinary retention, it is advisable to leave the urinary catheter in place for a longer period.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Steinhubl SR, Berger PB, Mann JT III, Fry ET, DeLago A, Wilmer C, Topol EJ, CREDO Investigators, Clopidogrel for the Reduction of Events During Observation (2002) Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial. JAMA 288:2411–2420

    Google Scholar 

  2. Gregorini L, Marco J, Fajadet J, Bernies M, Cassagneau B, Brunel P, Bossi IM, Mannucci PM (1997) Ticlopidine and aspirin pretreatment reduces coagulation and platelet activation during coronary dilation procedures. J Am Coll Cardiol 29:13–20

    Article  PubMed  CAS  Google Scholar 

  3. Chechi T, Vecchio S, Vittori G, Giuliani G, Lilli A, Spaziani G, Consoli L, Baldereschi G, Biondi-Zoccai GG, Sheiban I, Margheri M (2008) ST-segment elevation myocardial infarction due to early and late stent thrombosis a new group of high-risk patients. J Am Coll Cardiol 51:2396–2402

    Article  PubMed  Google Scholar 

  4. Mayor S (2006) Drug eluting stents are safe for licensed indications, FDA panel says. BMJ 333:1235

    Article  PubMed  Google Scholar 

  5. Silber S, Albertsson P, Avilés FF, Camici PG, Colombo A, Hamm C, Jørgensen E, Marco J, Nordrehaug JE, Ruzyllo W, Urban P, Stone GW, Wijns W (2005) Guidelines for percutaneous coronary interventions. The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology. Eur Heart J 26:804–847

    Article  PubMed  Google Scholar 

  6. Vicenzi MN, Meislitzer T, Heitzinger B, Halaj M, Fleisher LA, Metzler H (2006) Coronary artery stenting and non-cardiac surgery—a prospective outcome study. Br J Anaesth 96:686–693

    Article  PubMed  CAS  Google Scholar 

  7. O’Riordan JM, Margey RJ, Blake G, O’Connell PR (2009) Antiplatelet agents in the perioperative period. Arch Surg 144:69–76

    Article  PubMed  Google Scholar 

  8. Luckie MJ, Khattar RS, Fraser DG (2009) Noncardiac surgery and antiplatelet therapy following coronary artery stenting. Heart 95:1303–1308

    Article  PubMed  CAS  Google Scholar 

  9. Grines CL, Bonow RO, Casey DE Jr, Gardner TJ, Lockhart PB, Moliterno DJ, O’Gara P, Whitlow P (2007) Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians. Circulation 115:813–818

    Google Scholar 

  10. McFadden EP, Stabile E, Regar E, Cheneau E, Ong AT, Kinnaird T, Suddath WO, Weissman NJ, Torguson R, Kent KM, Pichard AD, Satler LF, Waksman R, Serruys PW (2004) Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy. Lancet 364:1519–1521

    Article  PubMed  CAS  Google Scholar 

  11. Jeremias A, Sylvia B, Bridges J, Kirtane AJ, Bigelow B, Pinto DS, Ho KK, Cohen DJ, Garcia LA, Cutlip DE, Carrozza JP Jr (2004) Stent thrombosis after successful sirolimus-eluting stent implantation. Circulation 109:1930–1932

    Article  PubMed  Google Scholar 

  12. Iakovou I, Schmidt T, Bonizzoni E, Ge L, Sangiorgi GM, Stankovic G, Airoldi F, Chieffo A, Montorfano M, Carlino M, Michev I, Corvaja N, Briguori C, Gerckens U, Grube E, Colombo A (2005) Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA 293:2126–2130

    Article  PubMed  CAS  Google Scholar 

  13. Ferrari E, Benhamou M, Cerboni P, Marcel B (2005) Coronary syndromes following aspirin withdrawal: a special risk for late stent thrombosis. J Am Coll Cardiol 45:456–459

    Article  PubMed  CAS  Google Scholar 

  14. Ong AT, Hoye A, Aoki J, van Mieghem CA, Rodriguez Granillo GA, Sonnenschein K, Regar E, McFadden EP, Sianos G, van der Giessen WJ, de Jaegere PP, de Feyter P, van Domburg RT, Serruys PW (2005) Thirty-day incidence and six-month clinical outcome of thrombotic stent occlusion after bare-metal, sirolimus, or paclitaxel stent implantation. J Am Coll Cardiol 45:947–953

    Article  PubMed  CAS  Google Scholar 

  15. Urban P, Gershlick AH, Guagliumi G, Guyon P, Lotan C, Schofer J, Seth A, Sousa JE, Wijns W, Berge C, Deme M, Stoll HP (2006) Safety of coronary sirolimus-eluting stents in daily clinical practice: one-year follow-up of the e-Cypher registry. Circulation 113:1434–1441

    Article  PubMed  CAS  Google Scholar 

  16. Tsimikas S (2006) Drug-eluting stents and late adverse clinical outcomes. J Am Coll Cardiol 47:2112–2115

    Article  PubMed  CAS  Google Scholar 

  17. Virmani R, Farb A, Guagliumi G, Kolodgie FD (2004) Drug-eluting stents: caution and concerns for long-term outcome. Coron Artery Dis 15:313–318

    Article  PubMed  Google Scholar 

  18. Eisenstein EL, Anstrom KJ, Kong DF, Shaw LK, Tuttle RH, Mark DB, Kramer JM, Harrington RA, Matchar DB, Kandzari DE, Peterson ED, Schulman KA, Califf RM (2007) Clopidogrel use and long-term clinical outcomes after drug-eluting stent implantation. JAMA 297:159–168

    Article  PubMed  CAS  Google Scholar 

  19. Tanzilli G, Greco C, Pelliccia F, Pasceri V, Barillà F, Paravati V, Pannitteri G, Gaudio C, Mangieri E (2009) Effectiveness of two-year clopidogrel + aspirin in abolishing the risk of very late thrombosis after drug-eluting stent implantation (from the TYCOON [Two-Year ClOpidOgrel Need] study). Am J Cardiol 104:1357–1361

    Article  PubMed  CAS  Google Scholar 

  20. Galløe AM, Thuesen L, Kelbaek H, Thayssen P, Rasmussen K, Hansen PR, Bligaard N, Saunamäki K, Junker A, Aarøe J, Abildgaard U, Ravkilde J, Engstrøm T, Jensen JS, Andersen HR, Bøtker HE, Galatius S, Kristensen SD, Madsen JK, Krusell LR, Abildstrøm SZ, Stephansen GB, Lassen JF (2008) Comparison of paclitaxel- and sirolimus-eluting stents in everyday clinical practice. JAMA 299:409–416

    Article  PubMed  Google Scholar 

  21. Mehta SR, Yusuf S, Peters RJ, Bertrand ME, Lewis BS, Natarajan MK, Malmberg K, Rupprecht H, Zhao F, Chrolavicius S, Copland I, Fox KA (2001) Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Lancet 358:527–533

    Article  PubMed  CAS  Google Scholar 

  22. de Korte FI, van Werkum JW, Vijverberg PL, Ten Berg JM (2008) Late coronary stent thrombosis complicating urologic surgery. Eur Urol 54:221–225

    Article  PubMed  Google Scholar 

  23. Carmignani L, Picozzi S (2009) Re: non-cardiac surgery and antiplatelet therapy following coronary artery stenting. Heart 95:1537

    Article  PubMed  CAS  Google Scholar 

  24. Sylvester R, Oosterlinck W, van der Meijden A (2004) A single immediate postoperative instillation of chemotherapy decreases the risk of recurrence in patients with stage Ta T1 bladder cancer: a meta-analysis of published results of randomized clinical trials. J Urol 71:2186–2190

    Article  Google Scholar 

  25. Sylvester RJ, van der Meijden AP, Oosterlinck W, Witjes A, Bouffioux C, Denis L, Newling D, Kurth K (2006) Predicting recurrence and progression in individual patients with stage TaT1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. Eur Urol 49:466–477

    Article  PubMed  Google Scholar 

Download references

Disclosures

Drs. Luca Carmignani, Stefano Picozzi, Robert Stubinski, Stefano Casellato, Giorgio Bozzini, Luca Lunelli, and Domenico Arena have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Urology Department, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy

    Luca Carmignani, Stefano Picozzi, Robert Stubinski, Stefano Casellato, Giorgio Bozzini, Luca Lunelli & Domenico Arena

Authors
  1. Luca Carmignani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stefano Picozzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert Stubinski
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stefano Casellato
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Giorgio Bozzini
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Luca Lunelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Domenico Arena
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stefano Picozzi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Carmignani, L., Picozzi, S., Stubinski, R. et al. Endoscopic resection of bladder cancer in patients receiving double platelet antiaggregant therapy. Surg Endosc 25, 2281–2287 (2011). https://doi.org/10.1007/s00464-010-1549-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-010-1549-1

Keywords

Search

Navigation