title: Stopping anticoagulation before TURP does not appear to increase perioperative cardiovascular complications.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors: Department of Urology, Westmead Hospital, Sydney, NSW, Australia.
authors: Mariolyn D
authors: MD
authors: Raj
authors: Colleen
authors: C
authors: McDonald
authors: Andrew J
authors: AJ
authors: Brooks
authors: Malcolm
authors: M
authors: Drummond
authors: Howard M
authors: HM
authors: Lau
authors: Manish I
authors: MI
authors: Patel
authors: Simon V
authors: SV
authors: Bariol
authors: Audrey C
authors: AC
authors: Wang
authors: Henry H
authors: HH
authors: Woo
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000209:etiology; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001145:Arrhythmias, Cardiac / Q000209:etiology; D001241:Aspirin / Q000008:administration & dosage; D001803:Blood Transfusion; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D019106:Postoperative Hemorrhage / Q000209:etiology*; D011300:Preoperative Care; D011468:Prostatectomy / Q000009:adverse effects*; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology; D020246:Venous Thrombosis / Q000209:etiology*; D014859:Warfarin / Q000008:administration & dosage
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D001241:Aspirin