MP06-15 POST OPERATIVE BLEEDING AND THOMBOTIC RISK FOR PATIENTS ON NOVEL ORAL ANTICOAGULANTS (NOAC) THERAPY UNDERGOING UROLOGICAL SURGERY

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy I (MP06)1 Sep 2021MP06-15 POST OPERATIVE BLEEDING AND THOMBOTIC RISK FOR PATIENTS ON NOVEL ORAL ANTICOAGULANTS (NOAC) THERAPY UNDERGOING UROLOGICAL SURGERY Modassar Awan, Eloise Merriott, Sybghat Rahim, Ibrahim Khawaja, Sam Datta, Khalid Saja, and Zafar Maan Modassar AwanModassar Awan More articles by this author , Eloise MerriottEloise Merriott More articles by this author , Sybghat RahimSybghat Rahim More articles by this author , Ibrahim KhawajaIbrahim Khawaja More articles by this author , Sam DattaSam Datta More articles by this author , Khalid SajaKhalid Saja More articles by this author , and Zafar MaanZafar Maan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001973.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is a paucity of urological published data on the risks of post-operative bleeding and thrombosis for patients that discontinue NOAC treatment perioperatively. The aim of this review was to establish the incidence of post operative bleeding and thrombotic complications for patients undergoing common, predominantly endourological procedures with a moderate or high risk of post-operative bleeding. METHODS: A review was undertaken for 109 successive patients on NOAC therapy undergoing urological surgery (99 males, 10 females, median age 75.7 years with the range of 48-92 years). Data from 58 patients was reviewed retrospectively, 51 patients prospectively. In all cases NOAC therapy was stopped and re-started peri-operatively on the basis of our local guidelines (Rahim et al, EAU 2017) or individualised haematological advice given to the pre assessment clinical team.Bleeding complications were noted and categorised accordingly: requiring blood transfusion, > 30 g/L Hb drop from baseline; haematuria requiring readmission; requirement for bladder washouts or a return to theatre. Electronic discharge summaries and patient notes linked to their respective primary care practices were used to search for any thrombotic events occurring within 30 days of NOAC therapy interruption. RESULTS: Of the 109 patients; 75 (68.8%) were on Apixaban, 22 (20.2%) on Rivaroxaban, 10 (9.2%) on Dabigatran, and 2 patients (1.8%) on Edoxaban. Procedures included TURBT (30), prostate biopsies (18), TURP (9), HoLEP (12), Ureteroscopy (15), prostate biopsies (18), other (25). The NOAC was stopped on average 49.7 hours prior to surgery. The NOAC was most commonly reinitiated 72 hours after surgery (median 72 hrs, mean 110 hrs, range 24-672 hrs). There was incomplete documentation for 37 patients on the timing of NOAC restart after surgery. Bleeding complications were noted in 4 patients (3.66%). Three of the 4 patients were on Apixaban (2.75%) and one patient was on Rivaroxaban (0.92%). One patient (0.92%) was taken back to theatre for bladder washout/cystodiathermy and the other three were managed satisfactorily with catheter irrigation. One patient (0.92%) required transfusion and two patients (1.84%) had a drop in haemoglobin (>30 g/L). It was noted that the NOAC was restarted later than recommended in two of the four patients with bleeding complications, as per the surgeon’s discretion. There were no thrombotic complications within 30 days of stopping NOACs in either the prospective or retrospective groups. CONCLUSIONS: Bleeding complications, after stopping and restarting NAOCs for patients undergoing predominantly endourological procedures appear to be uncommon (<4%). The bleeding rate is in keeping with established bleeding rates for TURP in publishes series. The risk of blood transfusion or return to theatre in our reviewed series was <1%. There were no thrombotic complications in the 109 patients reviewed within one month of surgery. Source of Funding: Nothing to declare © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e95-e95 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Modassar Awan More articles by this author Eloise Merriott More articles by this author Sybghat Rahim More articles by this author Ibrahim Khawaja More articles by this author Sam Datta More articles by this author Khalid Saja More articles by this author Zafar Maan More articles by this author Expand All Advertisement Loading ...