title: Perioperative Management of Antiplatelets and Anticoagulants Among Patients Undergoing Elective Transurethral Resection of the Prostate--A Single Institution Experience.
abstract: OBJECTIVE
  To evaluate current practice in the perioperative management of antiplatelets (AP) and anticoagulants (AC) among men undergoing elective transurethral resection of the prostate (TURP), as well as the associated perioperative bleeding and thromboembolic complications.
  
  
  METHODS
  Retrospective review of consecutive elective TURP patients in a single tertiary institution from January 2011 to December 2013 (n = 293). Data on the regular use of AP/AC and the perioperative management approach were collected from patients' electronic medical records. Bleeding and thromboembolic complications were assessed up to 30 days postoperative. Association between AP/AC use and perioperative complications was assessed using the Kruskall-Wallis test (continuous variables) and the Fisher exact test (categoric variables).
  
  
  RESULTS
  There were 107/293 (37%) patients receiving long-term AP while there were 25/293 (9%) patients receiving long-term AC. A total of 72/107 (67%) patients ceased AP on an average of 7.6 days preoperatively, while 35/107 (33%) continued receiving AP. Patients with coronary stents (62%) and coronary bypass graft (67%) were significantly more likely to continued receiving AP (P < 0.001). AC was ceased in all patients preoperatively, with 16/25 (64%) receiving enoxaparin bridging. Overall, there were 31 (10%) incidents of bleeding complications and 5 (2%) thromboembolic events. AC users who had enoxaparin bridging had significantly higher risk of bleeding complications (44%), compared with non-AP/AC users (8%), AP users who ceased AP (4%), AP users who continued receiving AP (17%), and AC users who did not receive enoxaparin bridging (0%) (P < 0.001). AC users who received enoxaparin bridging also reported significantly higher thromboembolic complications (17%; P < 0.001) and prolonged hospital stay (mean 5.4 days) (P = 0.002), compared with other patients.
  
  
  CONCLUSIONS
  Perioperative management of AP/AC should be based on the indications and the American College of Chest Physicians thromboembolic risk stratification. Regular AC users who had enoxaparin bridging are at increased risk of both perioperative bleeding and thromboembolic complications.
authors.affiliation: 1 Department of Urology, Alfred Health , Prahran, Victoria, Australia .|2 Department of Epidemiology and Preventive Medicine, Monash University , Prahran, Victoria, Australia .
authors.forename: Wee Loon
authors.initials: WL
authors.lastname: Ong
authors.affiliation: 3 Department of Surgery, Monash University , Prahran, Victoria, Australia .
authors.forename: Tze Lui
authors.initials: TL
authors.lastname: Koh
authors.affiliation: 1 Department of Urology, Alfred Health , Prahran, Victoria, Australia .
authors.forename: Jan
authors.initials: J
authors.lastname: Fletcher
authors.affiliation: 2 Department of Epidemiology and Preventive Medicine, Monash University , Prahran, Victoria, Australia .|3 Department of Surgery, Monash University , Prahran, Victoria, Australia .
authors.forename: Russell
authors.initials: R
authors.lastname: Gruen
authors.affiliation: 1 Department of Urology, Alfred Health , Prahran, Victoria, Australia .|3 Department of Surgery, Monash University , Prahran, Victoria, Australia .
authors.forename: Peter
authors.initials: P
authors.lastname: Royce
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use; D000068342:Aspirin, Dipyridamole Drug Combination / Q000627:therapeutic use; D000077144:Clopidogrel; D017558:Elective Surgical Procedures; D017984:Enoxaparin / Q000627:therapeutic use*; D006470:Hemorrhage / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000453:epidemiology*; D011467:Prostate; D011470:Prostatic Hyperplasia / Q000601:surgery*; D012189:Retrospective Studies; D013923:Thromboembolism / Q000453:epidemiology*; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D020728:Transurethral Resection of Prostate; D014739:Victoria / Q000453:epidemiology; D014859:Warfarin / Q000627:therapeutic use; D028761:Withholding Treatment
chemical_list: D000925:Anticoagulants; D000068342:Aspirin, Dipyridamole Drug Combination; D017984:Enoxaparin; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin