title: A retrospective study to assess the morbidity associated with transurethral prostatectomy in patients on antiplatelet or anticoagulant drugs.
abstract: What's known on the subject? and What does the study add? There is controversy over the use of anti-platelet and anti-coagulant drugs in men undergoing TURP with contradictory evidence on the effect of the drugs on bleeding following the operation, particularly for aspirin. If anti-platelet or anti-coagulant drugs are not stopped for TURP, there is an unacceptable burden of bleeding. If the drugs are stopped there is an unacceptable rate of cardiovascular events.
  
  
  OBJECTIVE
  • To determine the morbidity associated with perioperative management of antiplatelet (AP) or anticoagulant (AC) medication and transurethral prostatectomy.
  
  
  METHODS
  • A retrospective review was performed on 163 consecutive patients undergoing transurethural prostatectomy. • Patients were grouped according to the perioperative management of AP and AC medications: control patients not prescribed any AP/AC drugs (group 1), those on AP/AC who had ceased them perioperatively (group 2) and those whose AP/AC were continued (group 3). • Warfarin was withheld perioperatively for all patients. • Morbidity associated with increased blood loss and cardiovascular or cerebrovascular events was recorded and differences were analysed with SPSS version 16 software.
  
  
  RESULTS
  • There was a statistically significant increase in bleeding-associated morbidity in group 2 (13/65) and group 3 (6/7) compared with the controls (9/91) (P < 0.01). • Cardiovascular and cerebrovascular events were only seen in group 2 (6/65), statistically significantly higher than the event rate in the other groups (P ≤ 0.01). • All cardiovascular or cerebrovascular events occurred in patients prescribed these medications for secondary prevention.
  
  
  CONCLUSIONS
  • Patients taking AP or AC medications have a higher rate of perioperative bleeding compared with those who are not taking any. • However, for patients prescribed AP or AC medication for secondary prevention, withholding these medications results in an increased rate of cardiovascular and cerebrovascular complications. • Careful consideration of the risks and other management options should be undertaken before performing transurethural prostatectomy in this high risk group of patients.
authors.affiliation: Central Coast AHA - Department of Urology, Gosford, New South Wales, Australia.
authors.forename: Kellie
authors.initials: K
authors.lastname: Taylor
authors.forename: Rhys
authors.initials: R
authors.lastname: Filgate
authors.forename: Ding Yu
authors.initials: DY
authors.lastname: Guo
authors.forename: Finlay
authors.initials: F
authors.lastname: Macneil
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000517:prevention & control / Q000706:statistics & numerical data*; D002318:Cardiovascular Diseases / Q000209:etiology; D016022:Case-Control Studies; D002561:Cerebrovascular Disorders / Q000209:etiology; D006801:Humans; D008297:Male; D019990:Perioperative Care / Q000379:methods; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011470:Prostatic Hyperplasia / Q000601:surgery; D011471:Prostatic Neoplasms / Q000601:surgery; D012189:Retrospective Studies; D020728:Transurethral Resection of Prostate / Q000009:adverse effects*; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D001241:Aspirin