Discontinuation of Anticoagulant or Antiplatelet Therapy for Transrectal Ultrasound-Guided Prostate Biopsies: A Single-Center Experience

Abstract

PurposeHistorically, it was thought that hemorrhagic complications were increased with transrectal ultrasound-guided prostate biopsies (TRUS biopsy) of patients receiving anticoagulation/antiplatelet therapy. However, the current literature supports the continuation of anticoagulation/antiplatelet therapy without additional morbidity. We assessed our experience regarding the continuation of anticoagulation/antiplatelet therapy during TRUS biopsy.Materials and MethodsA total of 91 and 98 patients were included in the anticoagulation/antiplatelet (group I) and control (group II) groups, respectively. Group I subgroups consisted of patients on monotherapy or dual therapy of aspirin, warfarin, clopidogrel, or low molecular weight heparin. The TRUS biopsy technique was standardized to 12 cores from the peripheral zones. Patients completed a questionnaire over the 7 days following TRUS biopsy. The questionnaire was designed to assess the presence of hematuria, rectal bleeding, and hematospermia. Development of rectal pain, fever, and emergency hospital admissions following TRUS biopsy were also recorded.ResultsThe patients' mean age was 65 years (range, 52 to 74 years) and 63.5 years (range, 54 to 74 years) in groups I and II, respectively. The overall incidence of hematuria was 46% in group I compared with 63% in group II (p=0.018). The incidence of hematospermia was 6% and 10% in groups I and II, respectively. The incidence of rectal bleeding was similar in group I (40%) and group II (39%). Statistical analysis was conducted by using Fisher exact test.ConclusionsThere were fewer hematuria episodes in anticoagulation/antiplatelet patients. This study suggests that it is not necessary to discontinue anticoagulation/antiplatelet treatment before TRUS biopsy.

Emergency attendances and hospitalisations for complications after transrectal ultrasound-guided prostate biopsies: a five-year retrospective multicentre study

“…13 In the present study, we could not perform any temporal analyses of complications because the length of the study was insufficient; to the best of our knowledge, there have been no such temporal analyses in Hong Kong. The infection rate in our cohort was comparatively lower than that of most international studies, 4 and similar to that in prior studies elsewhere in Asia 14,15 (0% and 0.5% of PBI), as well as in Hong Kong 5,6 (0.5% and 3.9%). Reasons for the apparent lower infection rate in people of Asian ethnicity compared with those of other ethnicities are unclear.…”

Incidence of sepsis following transrectal ultrasound guided prostate biopsy at a tertiary-care medical center in Lebanon

“…However, other series of studies carried out by Carmignani et al, Akduman et al, and Simsir et al in reported higher rates of urosepsis (2.2%, 3.0%, and 3.06%, respectively) ( 16 , 24 , 25 ). Only one Asian study conducted by Raheem et al in 2012 reported no septic complications ( 26 ). This variation in rates of sepsis among different studies arises from differences in biopsy techniques, prophylactic protocols, consistent reporting, and the definition of urosepsis used.…”

Is it safe to continue antithrombotic agents before prostate biopsy?

“…There are some reports about prostate biopsy in patients continuing AP or AC 6, 7, 8, 9, 10, 11. Almost all reports showed that although continuation of AAs before prostate biopsy increased the frequency of minor bleeding complications or prolonged the duration of self-limited hematuria or rectal bleeding, it did not increase severe hemorrhagic complications.…”