You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology1 Apr 20112263 CARDIOVASCULAR MORBIDITY ASSOCIATED WITH THE DISCONTINUATION OF ANTICOAGULATION PRIOR TO TRANSURETHRAL RESECTION OF THE PROSTATE (TURP) Mariolyn Raj, Andrew Brooks, Malcolm Drummond, Howard Lau, Manish Patel, Simon Bariol, Audrey Wang, and Henry Woo Mariolyn RajMariolyn Raj Sydney, Australia More articles by this author , Andrew BrooksAndrew Brooks Sydney, Australia More articles by this author , Malcolm DrummondMalcolm Drummond Sydney, Australia More articles by this author , Howard LauHoward Lau Sydney, Australia More articles by this author , Manish PatelManish Patel Sydney, Australia More articles by this author , Simon BariolSimon Bariol Sydney, Australia More articles by this author , Audrey WangAudrey Wang Sydney, Australia More articles by this author , and Henry WooHenry Woo Sydney, Australia More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2506AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Men requiring surgery for bladder outflow obstruction who are taking anticoagulants create a challenge for urologists. The risks of peri-operative bleeding needs to be balanced against the risks of post-operative cardiovascular & cerebrovascular morbidity, which anticoagulation therapy aims to avoid. The incidence of morbidity directly associated with discontinuing anticoagulants is not well understood. The objective of this study was to retrospectively evaluate the impact of discontinuing anticoagulants medications for TURP. METHODS Retrospective series of 305 patients undergoing TURP at a tertiary referral hospital between 2006 & 2010. All men were evaluated in preadmission clinics with defined protocols with a low threshold for cardiovascular investigation. Incidence of post-operative & peri-operative bleeding & cardiovascular & cerebrovascular events was determined, for two patient cohorts; Group A; where anticoagulants were ceased pre-operatively and Group B; who were not receiving any anticoagulants. RESULTS N=305. Mean Age: 69.5y± 8.3. Median ASA 2 (IQR 2-3). Mean Operative time: 55.6 min± 28.7. Patients not receiving any anticoagulation 64% (194/305), vs. 35.4% (108/305) where anticoagulation ceased pre-TURP and 0.98% (3/305) where TURP was performed whilst on aspirin. Anticoagulants: Aspirin 22.6%, Warfarin 4.9%, Antiplatelets 4.9%, Combination treatments 3.9%. Incidence of post-op hemorrhage (early & delayed) was not statistically significant (P=0.69) between Group A (10/108) compared to Group B (7/194). Transfusion rate was 0.6% (2/305). Overall incidence of cardiovascular events 0.98% (Group A n=1 vs. Group B n= 2) and overall incidence of deep vein thrombosis 0.32% (Group A n= 0 vs. Group B n=1) was not statistically significant (P=0.30)& P=0.37) respectively. Overall incidence of cerebrovascular events 0.65% (Group A n=1 vs. Group B n=1) was not significant (P =1.00). There were no deaths. CONCLUSIONS Men undergoing TURP who have anticoagulation therapy discontinued prior to surgery do not appear to have a higher risk of cardiovascular morbidity, compared to men not taking anticoagulants. This result suggests that cardiovascular risk associated with discontinuing anticoagulation prior to TURP may be overstated. These positive outcomes should be considered in the context of experienced high volume surgeons, and well defined protocols for management of these high-risk men in a tertiary center. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e907 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mariolyn Raj Sydney, Australia More articles by this author Andrew Brooks Sydney, Australia More articles by this author Malcolm Drummond Sydney, Australia More articles by this author Howard Lau Sydney, Australia More articles by this author Manish Patel Sydney, Australia More articles by this author Simon Bariol Sydney, Australia More articles by this author Audrey Wang Sydney, Australia More articles by this author Henry Woo Sydney, Australia More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...