Stopping Anticoagulation Before TURP Does Not Appear to Increase Perioperative Cardiovascular Complications

• Published in: Urology (Ridgewood, N.J.) Vol. 78; no. 6; pp. 1380 - 1384
• Main Authors: Raj, Mariolyn D, McDonald, Colleen, Brooks, Andrew J, Drummond, Malcolm, Lau, Howard M, Patel, Manish I, Bariol, Simon V, Wang, Audrey C, Woo, Henry H
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.12.2011; Elsevier
• Subjects: Aged; Angina Pectoris - etiology; Anticoagulants - administration & dosage; Anticoagulants - adverse effects; Arrhythmias, Cardiac - etiology; Aspirin - administration & dosage; Biological and medical sciences; Blood Transfusion; Humans; Ischemic Attack, Transient - etiology; Male; Medical sciences; Middle Aged; Myocardial Infarction - etiology; Nephrology. Urinary tract diseases; Platelet Aggregation Inhibitors - administration & dosage; Postoperative Hemorrhage - etiology; Preoperative Care; Prostatectomy - adverse effects; Retrospective Studies; Stroke - etiology; Urology; Venous Thrombosis - etiology; Warfarin - administration & dosage; Perioperative; Nephrology; Treatment; Surgery; Cardiovascular disease; Surgical resection; Anticoagulant; Transurethral route; Urology
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2011.05.053

Objective To evaluate the impact of stopping anticoagulant medications prior to transurethral resection of the prostate on peri-operative cardiovascular complications. Methods Retrospective series (305 patients) undergoing TURP at a tertiary hospital between 2006 and 2010. All men were evaluated in preadmission clinics with defined protocols, with a low threshold for cardiovascular investigation. Incidence of postoperative bleeding and cardiovascular and cerebrovascular events was determined for 3 patient cohorts: group A—where anticoagulants were ceased preoperatively; group B—who were not receiving any anticoagulants; and group C—who underwent TURP while taking aspirin. Results Of 305 patients, 194 (64%) did not receive anticoagulation therapy, 108 (35%) stopped receiving anticoagulation therapy pre-TURP, and 3 (0.98%) underwent TURP while taking aspirin. Anticoagulants used were aspirin (22.6%), warfarin (4.9%), antiplatelets (4.9%), and combination treatments (3.9%). Incidence of postoperative hemorrhage (early and delayed) was not significant ( P = .69) between group A (10/108) and group B (7/194). Transfusion rate was 0.6% (2/305). Overall incidence of cardiovascular events was 0.98% (group A, n = 1 vs group B, n = 2), and incidence of deep vein thrombosis (0.32%; group A, n = 0 vs group B, n = 1) was not statistically significant ( P = .30 and P = .37, respectively). Overall incidence of cerebrovascular events (0.65%; group A, n = 1 vs group B, n = 1) was not significant ( P = 1.00). There were no deaths. Conclusion Men who have discontinue anticoagulation therapy before TURP do not appear to have a higher incidence of cardiovascular or cerebrovascular events, or bleeding-associated morbidity. It is possible that the morbidity attributed to discontinuing anticoagulation in this population may be overemphasized. Larger prospective studies are needed to better evaluate this clinical problem.