Thrombotic risk factors associated with transurethral prostatectomy.
OBJECTIVE
To ascertain the potential thrombotic risk associated with transurethral prostatectomy (TURP).


METHODS
The changes in coagulation variables were assessed in a prospective study of 40 patients undergoing TURP.


RESULTS
There was a significant increase in thrombin-antithrombin complexes 6 h after TURP (anova, P=0.01) combined with a significant decrease in activated partial thromboplastin time (anova, P=0.006), suggesting a postoperative hypercoagulable state. The significant increase in d-dimer 24 h after TURP (anova, P=0.015) in the absence of any significant rise in tissue plasminogen activator antigen levels perioperatively (anova, P=0.737) suggests a physiological fibrinolytic response to the developing procoagulant state. The absence of any significant increase in plasminogen activator inhibitor-1 antigen perioperatively (anova, P=0.348) suggests the observed hypercoagulability is not due to a 'fibrinolytic shutdown' reported in other forms of surgery.


CONCLUSIONS
TURP is associated with a hypercoagulable prothrombotic state; aspirin withdrawal perioperatively may be hazardous, and low-dose heparin prophylaxis for venous thrombosis should be considered.
Bell
C R
CR
Department of Urology, The Katherine Dormandy Haemophilia Centre, London, UK.
Murdock
P J
PJ
Pasi
K J
KJ
Morgan
R J
RJ
D000925:Anticoagulants / Q000627:therapeutic use; D001779:Blood Coagulation Factors / Q000032:analysis; D016063:Blood Loss, Surgical; D006487:Hemostasis; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects*; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology* / Q000517:prevention & control
D000925:Anticoagulants; D001779:Blood Coagulation Factors