Transurethral resection of the prostate in the anticoagulated patient.
OBJECTIVE
To assess the safety of transurethral prostatectomy (TURP) in patients on long-term full anticoagulation.


METHODS
Twelve TURPs were performed on 11 patients with urinary retention or severe symptoms from prostatic obstruction who also required anticoagulation for a history of life-threatening thromboembolic disease (seven) or prosthetic heart valves (four). Patients stopped taking warfarin 3 days before surgery; on admission a day later, full intravenous heparinization was commenced. Heparin was stopped 4 h before TURP and re-commenced with an initial bolus in the recovery room, and warfarin re-started that evening.


RESULTS
The mean weight of prostate resected was 23 g and the mean peri-operative decrease in haemoglobin was 1.6 g/dL. Only one patient required a transfusion of 3 units, but the activated partial thromboplastin time (APTT) had risen to >4. The mean pre- and post-operative APTT were 1.7 and 2.64, respectively, and the mean total length of hospital stay 6.7 days. Three patients were re-admitted for secondary haemorrhage at 8, 9 and 28 days after TURP, but all resolved with catheterization for 24 h only. There were no other major complications or thrombo-embolic phenomena.


CONCLUSIONS
TURP can be conducted safely in this high-risk group of patients with a regimen that allows a brief but controlled interruption to their full anticoagulation. This protects from the risks of thromboembolic incidents with no major increase in haemorrhage or hospital stay.
Chakravarti
A
A
Department of Urology, Torbay Hospital, Torquay, UK.
MacDermott
S
S
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D006801:Humans; D007902:Length of Stay; D008297:Male; D009364:Neoplasm Recurrence, Local; D019106:Postoperative Hemorrhage / Q000209:etiology; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000150:complications / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013923:Thromboembolism / Q000150:complications / Q000188:drug therapy; D016055:Urinary Retention / Q000209:etiology / Q000601:surgery*; D014859:Warfarin / Q000627:therapeutic use*
D000925:Anticoagulants; D014859:Warfarin