The efficacy and safety of perioperative low molecular weight heparin substitution in patients on chronic oral anticoagulant therapy undergoing transurethral prostatectomy for bladder outlet obstruction.
OBJECTIVE
Candidates for prostatectomy who require chronic anticoagulant therapy present a major perioperative management problem due to the threat of significant hemorrhage associated with surgery and the risk of thromboembolism associated with discontinuation of the anticoagulants. We evaluated prospectively a perioperative routine using low molecular weight heparin substitution to allow safe discontinuation of prophylactic oral anticoagulants in patients undergoing transurethral resection of the prostate.


METHODS
We treated 20 patients on chronic oral anticoagulant therapy who required prostatectomy for bladder outlet obstruction according to a prospective protocol based on exchange of the oral anticoagulants with perioperative injections of low molecular weight heparin and resumption of oral anticoagulants early postoperatively. The safety and efficacy of this regimen were assessed in comparison to a control group comprised of 20 randomly selected nonwarfarin treated patients who underwent prostatectomy during the same period.


RESULTS
The need for blood transfusions and mean number of units transfused did not significantly differ between the 2 groups. Due to persistent hematuria routine removal of the catheter was possible only in 9 of 20 patients (45%) in the heparin group compared to 18 of 20 (90%) in the control group. Average catheterization and hospitalization period in the heparin group was 3.2 days and 4.2 days respectively, compared to 2.1 and 2.1 days in the control group, respectively (p <0.01). No long-term hemorrhagic or thromboembolic complications were noted at 3 months postoperatively.


CONCLUSIONS
Despite longer hospitalization in the heparin treated group, our substitution protocol is safe and effective.
Dotan
Zohar A
ZA
Department of Urology, The Chaim-Sheba Medical Center, Tel-Hashomer, Israel.
Mor
Yoram
Y
Leibovitch
Ilan
I
Varon
David
D
Golomb
Jacob
J
Duvdevani
Mordechai
M
Ramon
Jacob
J
D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001803:Blood Transfusion; D005500:Follow-Up Studies; D006493:Heparin / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D011470:Prostatic Hyperplasia / Q000601:surgery*; D012307:Risk Factors; D020728:Transurethral Resection of Prostate; D016896:Treatment Outcome; D001748:Urinary Bladder Neck Obstruction / Q000601:surgery*
D000925:Anticoagulants; D006493:Heparin