title: [New oral anticoagulants and prostate biopsy: Which usual precaution should we use?].
abstract: BACKGROUND
  In 2013, more than 30,000 prostate biopsies have been performed in France. Bleeding complications are not rare. It imposes meticulous perioperative management in order to avoid them. In a close future, new oral anticoagulants (NOAC) will probably substitute vitamin K antagonist in many indications. The management of these new drugs is not really familiar in urology. The authors have specified it by using a systematic literature search in association to guidelines analysis edited by learned society.
  
  
  METHODS
  This article is based on a systematic literature search by using Pubmed database and by consulting international learned society of urology, anesthesiology or cardiology and the French National Agency of Drugs Security.
  
  
  RESULTS
  There was no guidelines edited by urological learned society. A standardized protocol adapted to prostate biopsies has been suggested using French Anesthesiologist and Hemostasian guidelines. The authors recommended stopping the oral anticoagulant treatment 5 days prior the biopsy. A bridge, by using a curative dose of heparin, was required during the preoperative period in order to manage the bleeding risk. It must be stopped 12 hours or 24 hours before biopsy (standard or low molecular weight heparin). Contrary to vitamin K antagonist, the re-initiation of the oral should begin 6-8 hours after procedure. The treatment should not overlap with heparin. The NOAC anticoagulant effect is quickly effective after 2 to 4 hours. The treatment should be re-initiated directly after the biopsy, in the absence of bleeding complications.
  
  
  CONCLUSIONS
  The perioperative management of new oral anticoagulants seems to be more simple than vitamin K antagonist (VKA) during prostate biopsy. A standardized protocol should be recommended.
authors.affiliation: Services d'urologie-transplantation, université Picardie Jules-Verne, CHU d'Amiens, 80000 Amiens, France. Electronic address: mathieu.coscarella@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Coscarella
authors.affiliation: Services d'urologie-transplantation, université Picardie Jules-Verne, CHU d'Amiens, 80000 Amiens, France; Laboratoire d'anatomie et d'organogenèse, université Picardie Jules-Verne, CHU d'Amiens, 80000 Amiens, France.
authors.forename: L
authors.initials: L
authors.lastname: Viart
authors.affiliation: Laboratoire HERVI (EA 3801), université Picardie Jules-Verne, CHU d'Amiens, 80000 Amiens, France; Service d'hématologie, université Reims Champagne Ardennes, CHU de Reims, 51100 Reims, France.
authors.forename: P
authors.initials: P
authors.lastname: Nguyen
authors.affiliation: Services d'urologie-transplantation, université Picardie Jules-Verne, CHU d'Amiens, 80000 Amiens, France; Laboratoire HERVI (EA 3801), université Picardie Jules-Verne, CHU d'Amiens, 80000 Amiens, France.
authors.forename: F
authors.initials: F
authors.lastname: Saint
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage*; D001706:Biopsy; D004334:Drug Administration Schedule; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D019990:Perioperative Care; D017410:Practice Guidelines as Topic; D011467:Prostate / Q000473:pathology*
chemical_list: D000925:Anticoagulants
keywords: Biopsies prostatiques; Complications; New oral anticoagulant (NOA); Nouveaux anticoagulants oraux (NACO); Prostate biopsy