title: Bladder outlet procedures in the setting of anticoagulation therapy.
abstract: OBJECTIVE
  To assess the safety and bleeding risk in men on chronic oral anticoagulation, including antiplatelet therapies, undergoing bladder outlet procedures for the treatment of benign prostatic hyperplasia (BPH).
  
  
  RESULTS
  There are conflicting findings; however, most recent series show that when treating bladder outlet obstruction from BPH in patients on chronic anticoagulants, there is an increased risk of hemorrhagic complications for these men. There is also an increased risk of cardiovascular and cerebrovascular complications, especially when antithrombotic therapy is used for secondary prevention and is withdrawn perioperatively. Some have found bipolar electrosurgical vaporization of the prostate, laser vaporization, and enucleation of the prostate to provide superior hemostatic outcomes compared to classic monopolar transurethral resection of the prostate.
  
  
  CONCLUSIONS
  Extra caution should always be given to patients on chronic anticoagulation undergoing surgical procedures, given increased risk of bleeding and cardiovascular and cerebrovascular complications. For men with BPH undergoing bladder outlet procedures, photoselective vaporization of the prostate, Holmium laser enucleation of the prostate, and vaporization of the prostate with bipolar electrosurgical instruments may result in less bleeding complications. Further prospective randomized studies are needed to elucidate which methods provide better hemostasis and lower postoperative bleeding to best manage men with BPH on chronic antithrombotic therapy, especially when the anticoagulation therapy cannot be discontinued prior to therapy.
authors.affiliation: Department of Urology, New York University School of Medicine, NYU Langone Medical Center, New York, New York, USA.
authors.forename: Tracy
authors.initials: T
authors.lastname: Marien
authors.forename: Ojas
authors.initials: O
authors.lastname: Shah
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000517:prevention & control; D006470:Hemorrhage / Q000453:epidemiology*; D006801:Humans; D008297:Male; D011470:Prostatic Hyperplasia / Q000601:surgery*; D012307:Risk Factors; D020521:Stroke / Q000517:prevention & control; D001748:Urinary Bladder Neck Obstruction / Q000601:surgery*
chemical_list: D000925:Anticoagulants