Biopsy of the prostate guided by transrectal ultrasound: relation between warfarin use and incidence of bleeding complications

Ihezue, C.U.; Smart, J; Dewbury, K. C.; Mehta, Rajnikant; Burgess, Lawrence P. A.

doi:10.1016/j.crad.2004.10.014

Cited by 72 publications

(34 citation statements)

References 17 publications

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“…There was no significant increase in the incidence of hematuria or rectal bleeding among the aspirin users [43]. In the second study, even warfarin (49 patients) did not increase the frequency and severity of bleeding complications compared to the control group (731 patients) [44]. This is in contrast to the Hong Kong study [28] where warfarin use was found to be an independent risk factor for postpolypectomy bleeding (OR 13.4).…”

Section: Antiplatelet Therapy and Non-gastrointestinal Invasive Procecontrasting

confidence: 50%

Antiplatelet Therapy and the Risk of Bleeding Induced by Gastrointestinal Endoscopic Procedures

et al. 2007

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Antiplatelet drugs may increase the risk of bleeding induced by gastrointestinal endoscopic procedures. The antiplatelet effect of cyclooxygenase-1 inhibitors lasts less than 4 h. Skin and colonic bleeding times are prolonged for 3 and 5 days after aspirin and ticlopidine withdrawal respectively. Major bleeding from endoscopic biopsies is extremely rare. In the four recent largest series, the general incidence of polypectomy-induced major bleeding was 0.11–0.42%. In more than half of the cases the bleeding was delayed, usually up to 2 weeks after the endoscopy. Although three retrospective studies suggested that aspirin does not increase the risk of polypectomy-induced bleeding, the power of these studies is limited. Similarly, it is difficult to draw conclusions from the two studies that assessed the risk of aspirin use during sphincterotomy. Aspirin withdrawal may be harmful in susceptible patients, mainly if it is for more than 7 days. There is no indication to stop aspirin before esophagogastroduodenoscopy, which may reveal aspirin-induced lesions. We recommend discontinuation of aspirin 4–7 days (according to the cardiovascular risk) before other endoscopic procedures. When aspirin is indicated for primary prevention, it can be resumed 14 and 10 days after polypectomy and sphincterotomy respectively. In cases of secondary prevention, it should be resumed after 1 week.

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Section: Antiplatelet Therapy and Non-gastrointestinal Invasive Procecontrasting

confidence: 50%

Antiplatelet Therapy and the Risk of Bleeding Induced by Gastrointestinal Endoscopic Procedures

et al. 2007

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“…reported no difference in incidence, duration or severity of bleeding in men using warfarin before TRUS-guided PB 21 . Accordingly, high-risk patients on low-dose aspirin or warfarin may have greater risk from AC/AP withdrawal than the risk of a serious bleeding complication.…”

Section: Use Of Anticoagulants and Bleeding Complicationsmentioning

confidence: 98%

Complications After Systematic, Random, and Image-guided Prostate Biopsy

et al. 2017

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Evidence Synthesis: The most frequent complication after PB is minor and self-limiting bleeding (hematuria and hematospermia), irrespective of the biopsy approach. Occurrence of rectal bleeding was comparable among traditional TRUS-guided and image-guided PB. Almost 25% of patients experience lower urinary tract symptoms, but only a few have urinary retention, with higher rates after transperineal approach. Temporary erectile dysfunction is not negligible, with a return to baseline after 1-6 months. The incidence of infective complications is being increasing, with higher rates among men with medical comorbidities and older age. Transperineal and in-bore MRI targeted biopsy may reduce the risk of severe infectious complications. Mortality after PB is uncommon, irrespective of biopsy technique. Conclusions:Complications after PB are frequent but often self-limiting. The incidence of hospitalization due to severe infections is continuously increasing. Still, a careful appraisal of 3 patient's general health status, risk factors and likelihood of antimicrobial resistance should be done before scheduling a PB. Patient Summary:In this paper we reviewed the variety and incidence of complications after prostate biopsy. Even if frequent, seldom represent a problem for the patient. The most troublesome complications are infections. In order to minimize this risk, a careful evaluation of patient's medical condition must be done before biopsy.4

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“…1,2, 13 The incidence of bleeding complications has not been shown to increase with either coumadin use or with the use of acetylsalicylic acid. 14,15 Our approach to managing significant or massive bleeding is to initially apply pressure to contain the bleeding or tamponade using an inflated Foley catheter in the rectum. Urinary retention is a common complication.…”

Section: Discussionmentioning

confidence: 99%

Catastrophic sepsis and hemorrhage following transrectal ultrasound guided prostate biopsies

Toren

Razik

Trachtenberg

2013

CUAJ

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We report 2 cases of catastrophic complications following routine transrectal ultrasound guided prostate biopsy. The first patient incurred near-fatal septic shock due to multi-resistant Escherichia coli. Due to the severity of his shock, he developed bilateral leg gangrene requiring amputations. The second patient incurred significant hemorrhage eventually requiring an emergent general anesthesia and surgical management to control hemorrhage after other measures failed. While rare events, these reports emphasize the caution needed for physicians who routinely order prostate biopsies.Can Urol Assoc J 2010;4(1):E12-E14 Case 1A 63-year-old diabetic underwent transrectal ultrasound (TRUS)-guided prostate biopsy for an elevated PSA of 5.7 ng/mL and no findings on digital rectal examination (DRE). His past medical history included coronary bypass surgery, dyslipidemia and previous hospital admission for bronchitis. He smoked half a pack of cigarettes per day for 25 years.The day prior to his biopsy, he was initiated on ciprofloxacin 500 mg orally, 2 times a day. The night after his biopsy, he presented to the emergency room with a fever, chills, pain and breathlessness. He appeared septic, with a systolic blood pressure of 75 mmHg, temperature 39º C. Initial white blood count (WBC) was 1.1, with a critically low neutrophil count of 0.44. He was given fluids, ceftriaxone and flagyl in the emergency room. Subsequently, he was transferred to the intensive care unit (ICU) and started on ionotropes and empiric meropenem. He developed hypoxia and was intubated and sedated.During the first 4 days of admission, he continued to be unstable and hypotensive requiring ionotropic support and developing shock liver and renal failure. Solucortef and caspofungin were started; he also received a dose of amikacin. His WBC peaked at 42 on the fourth day of admission. Platelets remained very low at 21 and his international normalized ratio (INR) increased from normal to 2.13. Multi-resistant Escherichia coli was cultured from his blood and was initially only sensitive to amikacin, but eventually also found to be sensitive to meropenem.Against expectations, he survived and slowly recovered. A tracheostomy was performed, and he was eventually weaned off ventilation. As a result of his severe sepsis, he developed bilateral feet gangrene requiring bilateral below knee amputations. Further, he incurred ototoxicity requiring hearing aids. His thrombocytopenia, renal and liver failure resolved over time. He was in the ICU for a total of 46 days and in hospital for 85 days.His prostate biopsy did not show any evidence of malignancy. Case 2A 65-year-old pediatrician was sent for a TRUS biopsy of the prostate for a prostate-specific antigen (PSA) of 10.56 mg/L and a suspicious DRE. His medical history included coronary artery disease with previous coronary artery bypass grafting, hypertension and hypercholesterolemia. He had a mitral valve annuloplasty for mitral regurgitation. He experienced bleeding at the biopsy site immediately after ...

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Biopsy of the prostate guided by transrectal ultrasound: relation between warfarin use and incidence of bleeding complications

Cited by 72 publications

References 17 publications

Antiplatelet Therapy and the Risk of Bleeding Induced by Gastrointestinal Endoscopic Procedures

Antiplatelet Therapy and the Risk of Bleeding Induced by Gastrointestinal Endoscopic Procedures

Complications After Systematic, Random, and Image-guided Prostate Biopsy

Catastrophic sepsis and hemorrhage following transrectal ultrasound guided prostate biopsies

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