Continuing or discontinuing low-dose aspirin before transrectal prostate biopsy: results of a prospective randomized trial.
OBJECTIVE
To determine whether the incidence and duration of bleeding complications after transrectal prostate biopsy (PB) in patients not discontinuing low-dose aspirin (LDA) are greater than in those discontinuing it.


METHODS
A total of 200 consecutive subjects taking chronic LDA were enrolled in a prospective trial and were randomly assigned to undergo transrectal PB while continuing LDA (group 1, n = 67), replacing LDA with low-molecular-weight heparin (group 2, n = 67), or discontinuing LDA (group 3, n = 66). The incidence and duration of hematuria, rectal bleeding, and hematospermia for each group were assessed with a self-administered questionnaire. On days 14 and 30 after PB, all men were evaluated with an outpatient visit and a telephone interview, respectively.


RESULTS
The cohort comprised 196 assessable subjects. The median number of biopsy cores taken was 10 (range 6 to 10). The overall bleeding rate was 78.5%, 69.7%, and 81.5% in groups 1, 2, and 3, respectively (P = 0.26). No significant difference was found for hematuria, rectal bleeding, or hematospermia among the groups. No severe bleeding complications occurred. The median duration of hematuria and rectal bleeding was significantly greater statistically in groups 1 and 2 compared with group 3 (6, 4, and 2 days versus 3, 2, and 1 days, respectively; P <0.0001). The proportion of men still reporting hematospermia at 30 days after PB was 21.4%, 18.5%, and 9.3% in groups 1, 2, and 3, respectively (P = 0.2).


CONCLUSIONS
The continued use of LDA in men undergoing transrectal PB did not increase the incidence of mild bleeding complications, although it prolonged the duration of self-limiting hematuria and rectal bleeding. Its effect, however, on severe bleeding remains to be determined.
Giannarini
Gianluca
G
Department of Urology, University of Pisa, Pisa, Italy. gianluca.giannarini@hotmail.it
Mogorovich
Andrea
A
Valent
Francesca
F
Morelli
Girolamo
G
De Maria
Maurizio
M
Manassero
Francesca
F
Barbone
Fabio
F
Selli
Cesare
C
D000368:Aged; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D001707:Biopsy, Needle / Q000009:adverse effects*; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006417:Hematuria / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D051516:Hemospermia / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D012007:Rectum; D011795:Surveys and Questionnaires
D006495:Heparin, Low-Molecular-Weight; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin