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Lee T, D'Souza K, Hameed A, Yao J, Lam S, Chadban S, Ying T, Celermajer D, Sandroussi C, Pleass HCC, Laurence JM. Comparison of the effect of single vs dual antiplatelet agents on post-operative haemorrhage after renal transplantation: A systematic review and meta-analysis. Transplant Rev (Orlando) 2020; 35:100594. [PMID: 33482617 DOI: 10.1016/j.trre.2020.100594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES A significant proportion of renal transplant patients have cardiovascular comorbidities for which they receive treatment with antiplatelet agents. The aim of this study was to systematically review the current literature reporting perioperative outcomes for patients receiving dual antiplatelet therapy compared to single antiplatelet therapy at the time of kidney transplantation with particular reference to the risks of postoperative haemorrhage. MATERIALS AND METHODS Embase, Medline and Cochrane databases were utilized to identify articles reporting outcomes of renal transplant recipients on single antiplatelet therapy and dual antiplatelet therapy. These outcomes were compared using a random effects model meta-analysis where appropriate. RESULTS Six articles were incorporated in the analysis, including 130 receiving dual antiplatelet therapy, and 781 in the single antiplatelet therapy group. There was a significantly higher risk of post-operative haemorrhagic events in the dual antiplatelet therapy group compared to the single antiplatelet therapy group (RR 1.58, 95% CI 1.19-2.09, p = 0.001). Post-operative cardiovascular event rates were similar between both groups in individual studies, although this could not be quantitatively analysed. CONCLUSIONS The use of dual antiplatelet therapy was associated with a higher risk of post-operative haemorrhage compared to the use of single antiplatelet therapy without increased rates of surgical intervention. However, the use of dual antiplatelet therapy may provide protection from cardiovascular events in an inherently higher risk patient group.
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Affiliation(s)
- Taina Lee
- Department of Surgery, Westmead Hospital, Corner of Hawkesbury Rd and Darcy, Westmead NSW 2145, Australia; Royal Prince Alfred Hospital, Missenden Road, Camperdwon, NSW 2050, Australia
| | | | - Ahmer Hameed
- Department of Surgery, Westmead Hospital, Corner of Hawkesbury Rd and Darcy, Westmead NSW 2145, Australia
| | - Jinna Yao
- Royal Prince Alfred Hospital, Missenden Road, Camperdwon, NSW 2050, Australia
| | - Susanna Lam
- Royal Prince Alfred Hospital, Missenden Road, Camperdwon, NSW 2050, Australia
| | - Steven Chadban
- Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdwon, NSW 2050, Australia; University of Sydney Medical School, Australia
| | - Tracey Ying
- Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdwon, NSW 2050, Australia; University of Sydney Medical School, Australia
| | - David Celermajer
- University of Sydney Medical School, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Camperdwon, NSW 2050, Australia
| | - Charbel Sandroussi
- RPA Institute of Academic Surgery, University of Sydney, RPA Institute of Academic Surgery, Level 9 E, Tranplantation Services, Missenden Road, Camperdwon, NSW 2050, Australia.; Royal Prince Alfred Hospital, Missenden Road, Camperdwon, NSW 2050, Australia
| | - Henry Claud Capron Pleass
- Department of Surgery, Westmead Hospital, Corner of Hawkesbury Rd and Darcy, Westmead NSW 2145, Australia; Royal Prince Alfred Hospital, Missenden Road, Camperdwon, NSW 2050, Australia
| | - Jerome Martin Laurence
- RPA Institute of Academic Surgery, University of Sydney, RPA Institute of Academic Surgery, Level 9 E, Tranplantation Services, Missenden Road, Camperdwon, NSW 2050, Australia.; Department of Surgery, Westmead Hospital, Corner of Hawkesbury Rd and Darcy, Westmead NSW 2145, Australia; Royal Prince Alfred Hospital, Missenden Road, Camperdwon, NSW 2050, Australia.
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Godier A, Garrigue D, Lasne D, Fontana P, Bonhomme F, Collet JP, de Maistre E, Ickx B, Gruel Y, Mazighi M, Nguyen P, Vincentelli A, Albaladejo P, Lecompte T. Management of antiplatelet therapy for non elective invasive procedures of bleeding complications: proposals from the French working group on perioperative haemostasis (GIHP), in collaboration with the French Society of Anaesthesia and Intensive Care Medicine (SFAR). Anaesth Crit Care Pain Med 2019; 38:289-302. [DOI: 10.1016/j.accpm.2018.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 10/07/2018] [Indexed: 12/12/2022]
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Godier A, Garrigue D, Lasne D, Fontana P, Bonhomme F, Collet JP, de Maistre E, Ickx B, Gruel Y, Mazighi M, Nguyen P, Vincentelli A, Albaladejo P, Lecompte T. Management of antiplatelet therapy for non-elective invasive procedures or bleeding complications: Proposals from the French Working Group on Perioperative Haemostasis (GIHP) and the French Study Group on Thrombosis and Haemostasis (GFHT), in collaboration with the French Society for Anaesthesia and Intensive Care (SFAR). Arch Cardiovasc Dis 2019; 112:199-216. [DOI: 10.1016/j.acvd.2018.10.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 10/09/2018] [Indexed: 12/21/2022]
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Rodríguez Faba O, Boissier R, Budde K, Figueiredo A, Taylor CF, Hevia V, Lledó García E, Regele H, Zakri RH, Olsburgh J, Breda A. European Association of Urology Guidelines on Renal Transplantation: Update 2018. Eur Urol Focus 2018; 4:208-215. [PMID: 30033070 DOI: 10.1016/j.euf.2018.07.014] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 06/21/2018] [Accepted: 07/11/2018] [Indexed: 12/20/2022]
Abstract
CONTEXT The European Association of Urology (EAU) panel on renal transplantation (RT) has released an updated version of the RT guidelines. OBJECTIVE To present the 2018 EAU guidelines on RT. EVIDENCE ACQUISITION A broad and comprehensive scoping exercise was performed, encompassing all areas of RT guidelines published between January 1, 2007, and May 31, 2016. Databases covered by the search included Medline, Embase, and the Cochrane Libraries. Previous guidelines were updated, and levels of evidence and grades of recommendation were assigned. EVIDENCE SYNTHESIS It is strongly recommended to offer pure or hand-assisted laparoscopic/retroperitoneoscopic surgery as the preferential technique for living donor nephrectomy. Decisions on the acceptance of a donor organ should not be based on histological findings alone since this might lead to an unnecessarily high rate of discarded grafts. For ureterovesical anastomosis, a Lich-Gregoir-like extravesical technique protected by a ureteral stent is the preferred technique for minimisation of urinary tract complications. It is also strongly recommended to perform initial rejection prophylaxis with a combination therapy comprising a calcineurin inhibitor (preferably tacrolimus), mycophenolate, steroids, and an induction agent (either basiliximab or anti-thymocyte globulin). The long version of the guidelines is available at the EAU website (http://uroweb.org/guidelines). CONCLUSIONS These abridged EAU guidelines present updated information on the clinical and surgical management of RT for incorporation into clinical practice. PATIENT SUMMARY The European Association of Urology has released the renal transplantation guidelines. The implementation of minimally invasive surgery for organ retrieval and the latest evidence on transplant surgery as well as on immunosuppressive regimens are key factors for minimisation of rejection and achievement of long-term graft survival.
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Affiliation(s)
- Oscar Rodríguez Faba
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain.
| | - Romain Boissier
- Aix-Marseille University, Marseille, France; Department of Urology & Renal Transplantation, La Conception University Hospital, Assistance-Publique Marseille, France
| | - Klemens Budde
- Department of Nephrology, Charité Medical University Berlin, Berlin, Germany
| | - Arnaldo Figueiredo
- Department of Urology and Renal Transplantation, Coimbra University Hospital, Coimbra, Portugal
| | - Claire Fraser Taylor
- Department of Urology and Transplant, St Georges NHS Trust Hospitals, London, UK
| | - Vital Hevia
- Urology Department, Hospital Universitario Ramón y Cajal, Alcalá University, Madrid, Spain
| | - Enrique Lledó García
- Department of Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Heinz Regele
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Rhana Hassan Zakri
- Department of Urology and Transplant, Guy's & St Thomas' NHS Trust Hospitals, London, UK
| | - Jonathon Olsburgh
- Department of Urology and Transplant, Guy's & St Thomas' NHS Trust Hospitals, London, UK
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
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Abstract
Determining practice parameters for interventional procedures is challenging due to many factors including unreliable laboratory tests to measure bleeding risk, variable usage of standardized terminology for adverse events, poorly defined standards for administration of blood products, and the growing numbers of anticoagulant and antiplatelet medications. We aim to address these and other issues faced by radiologists performing invasive procedures through a review of available literature, and experiential guidance from three academic medical centers. We discuss the significant limitations with respect to using prothrombin-time and international normalized ratio to measure bleeding risk, especially in patients with synthetic defects due to liver function. Factors affecting platelet function including the impact of uremia; recent advances in laboratory testing, including platelet function testing; and thromboelastography are also discussed. A review of the existing literature of fresh-frozen plasma replacement therapy is included. The literature regarding comorbidities affecting coagulation including malignancy, liver failure, and uremia are also reviewed. Finally, the authors present a set of recommendations for laboratory thresholds, corrective transfusions, as well as withholding and restarting medications.
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