Meta‑analysis of the effect of antithrombotic drugs on perioperative bleeding in BPH surgery

Abstract

Effects of antithrombotic agents on the bleeding risk after transurethral resection of the prostate (TURP) were assessed in patients with benign prostatic hyperplasia (BPH). Controlled clinical trials on the effects of perioperative anticoagulant therapy on postoperative bleeding in BPH patients published during January 1990 and February 2019 were searched in PubMed, Embase and the Cochrane Library. Two independent reviewers screened the studies according to the inclusion and exclusion criteria, extracted the data, evaluated the quality, and conducted a meta-analysis using the RevMan 5.3 software. A total of 20 studies were included. Analysis of these studies found that compared with interrupted use of antithrombotic agents, continuous use of antithrombotic drugs led to more frequent post-TURP bleeding (OR=4.34, 95% CI=2.29-8.23), and higher transfusion rate (2.96, 1.19-7.36). Compared with patients who never used antithrombotic agents, those who used antithrombotic agents continuously had higher bleeding risk (5.52, 1.64-18.66). Those who continued using antithrombotic agents during laser treatment had higher transfusion rate than those who stopped using them before the operation (5.39, 1.49-19.53), but it had no significant difference in clot retention, blood transfusion rate, intraoperative hemoglobin decrease and postoperative catheter-indwelling time compared with those who never used antithrombotic agents (P>0.05). Those who continued using antithrombotic agents during TURP showed less intraoperative hemoglobin decrease (-0.46,-0.58-0.35) than the patients who underwent low molecular weight heparin substitution. Interruption of antithrombotic agents during TURP can prevent the risk of postoperative bleeding; continuous use of antithrombotic agents is safe and feasible during laser treatment of BPH; whether low molecular weight heparin substitution is necessary during the discontinuation of antithrombotic agents is controversial.

Analysis of Risk Factors and Nursing Strategies for Postoperative Hemorrhage of Benign Prostatic Hyperplasia

“…Surgical excision is a common treatment method used for BPH in clinical practice [ 3 ]. However, some patients may suffer from postoperative bleeding due to the fragility of the fossa at the prostate to surgical interference, which compromises the curative effect [ 4 ]. Therefore, postoperative bleeding of BPH is a major clinical issue to be addressed [ 5 , 6 ].…”

Anticoagulant but not antiplatelet use is associated with haematuria complications after bladder outflow surgery

“…3 However, there is some evidence that the risk of requiring transfusion and bleeding complications increases if anticoagulation is continued perioperatively. 7 Low molecular weight heparin (LMWH) has a shorter half-life than long-term anticoagulants. Thus, when is it used for bridging therapy, the non-anticoagulated state can be achieved more quickly peri-operatively and if bleeding complications develop.…”