Perioperative Safety in Patient Under Oral Anticoagulation During Holmium Laser Enucleation of the Prostate

Becker, Benedikt; Netsch, Christopher; Hansen, Jens; Böhme, Axel; Gross, Andreas J.; Zacharias, Mario; Lehrich, Karin

doi:10.1089/end.2018.0693

Cited by 24 publications

(10 citation statements)

References 27 publications

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“…8 Furthermore, our report, to the best of our knowledge, is the second to report on DOAC intake in patients undergoing HoLEP. 27 Our findings are in line with Becker and colleagues, 27 who in a cohort of 94 patients on DOAC-as compared with patients not receiving blood thinning agents-found significantly longer catheterization time (2.2 days [mean] and 2.6 days [mean], p < 0.001), tamponades or bleeding requiring intervention (7.9% and 3.9%, respectively, p < 0.003). The analysis was, however, not confirmed in a multivariable model.…”

Section: Discussionsupporting

confidence: 90%

“…28 While it is possible that renal function may have impacted the metabolization of DOAC, or that there was an incongruence in perioperative management (patients may simply have failed to pause medication as recommended) it may also be that the recommendation of perioperative DOAC management, which stems from nonurological procedures, ought to be adapted to the specifics of endourological prostate surgery. 27 Our study has some limitations, including its retrospective data collection and review. As such, the granularity of preoperatively known and complicating factors of LUTS (e.g., neurological disease, urodynamically proven detrusor underactivity) and consequently postoperative outcomes were limited and prevented us to decidedly address these possible confounders.…”

Section: Discussionmentioning

confidence: 98%

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Assessing the Outcome of Holmium Laser Enucleation of the Prostate by Age, Prostate Volume, and a History of Blood Thinning Agents: Report from a Single-Center Series of >1800 Consecutive Cases

Gild

Lenke

Pompe

et al. 2021

Journal of Endourology

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Purpose: To assess perioperative outcomes of holmium laser enucleation of the prostate (HoLEP) in a realworld scenario and with a focus on demanding patient factors, such as large prostate size, advanced patient age, and anticoagulation therapy (AT). Materials and Methods: We retrospectively analyzed HoLEP procedures at our institution between 2010 and 2016. After stratification by prostate volume, age, and AT, perioperative and early voiding characteristics were compared. A multivariable regression model was employed to identify predictors of prolonged time of catheterization (defined as being above group's median). Results: The study cohort consisted of 1816 men with a median age of 71 years (interquartile range [IQR]: 66-76), a median prostate volume of 80 mL (IQR: 58-105), and American Society of Anesthesiologists score ‡3 in 618 men (34%). Median time of enucleation and morcellation was 43 minutes (IQR: 31-60) and 10 minutes (IQR: 6-18), respectively. Perioperative blood transfusions were administered in 44 (2.4%) cases, severe postoperative complications (Clavien-Dindo grade ‡3b) occurred in 61 (3.3%) cases. The median time of catheterization was 2 days (IQR: 2-2), with prolonged catheterization occurring in 277 (15%) cases. After adjustment, large prostates (fourth volume quartile [106-280 mL]) (odds ratio [OR]: 1.8, 95% confidence interval [CI]: 1.3-2.6, p = 0.001), therapeutic low-molecular-weight heparin bridging regimen (OR: 2.2, 95% CI: 1.4-3.6, p = 0.037), low-dose acetylsalicylic acid (OR: 1.5, 95% CI: 1.0-2.2, p = 0.015), and a history of direct oral anticoagulation (OR: 2.3, 95% CI: 1.2-4.0, p = 0.022), but not patient age, were independently associated with prolonged catheterization. Conclusions: We confirm HoLEP as safe and efficient; however, patients with large prostates and patients with a history of AT are at risk of prolonged catheterization.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 98%

Assessing the Outcome of Holmium Laser Enucleation of the Prostate by Age, Prostate Volume, and a History of Blood Thinning Agents: Report from a Single-Center Series of >1800 Consecutive Cases

Gild

Lenke

Pompe

et al. 2021

Journal of Endourology

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“…Accordingly, no worse outcomes were observed regarding the rate of blood transfusions or major complications such as operative revisions (0–4.3% in AT vs. 6.1% in no AT patients). A large study reporting the outcome of 2,178 patients (of whom 245 either took NOACs or Coumarins), analyzed by Becker et al [ 18 ] in 2019, also reported a higher overall complication rate in patients taking AT. However, they did not classify according to Clavien–Dindo classification.…”

Section: Discussionmentioning

confidence: 99%

Holmium laser enucleation of the prostate: efficacy, safety and preoperative management in patients presenting with anticoagulation therapy

et al. 2020

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Purpose We evaluated efficacy and safety profile of patients with anticoagulation therapy (AT) undergoing holmium laser enucleation of the prostate (HoLEP). Methods Within our prospective institutional database (11/2017 to 11/2019), we analyzed functional outcomes and 30-day complication rates of HoLEP patients according to Clavien–Dindo classification (CLD), stratified according to specific AT vs. no AT. Further analyses consisted of uni- and multivariate logistic regression models (LRM) predicting complications. Results Of 268 patients undergoing HoLEP, 104 (38.8%) received AT: 25.7% were treated with platelet aggregation inhibitors (PAI), 8.2% with new oral anticoagulants (NOAC) and 4.9% with AT-combinations or coumarins bridged with low molecular weight heparins (LMWH/combination). Patients receiving AT were significantly more comorbid (p < 0.01). Pre- and postoperative maximal flow rates, residual void urine and IPSS at 3 months after surgery were invariably improved after HoLEP for patients with/ without AT. Overall complication rate was 19.5% in patients with no AT vs. 26.1% vs. 27.3 vs. 46.2%, respectively, in patients with PAI, NOAC and LMWH/combination (p < 0.01). Major complications (CLD ≥ 3b) occurred in 6.1% of no AT patients vs. 4.3% vs. 4.5 vs. 0% in patients with PAI, NOAC and LMWH/combination, respectively (p < 0.01). In multivariate LRM, AT was not significantly associated with higher complication rates, whereas high ASA status (OR 2.2, p = 0.04), age (OR 1.04, p = 0.02) and bioptical or incidental prostate cancer (OR 2.5, p = 0.01) represented independent risk factors. Conclusion Despite higher overall complication rates in AT patients, major complications were not more frequent in AT patients. HoLEP is safe and effective in anticoagulated patients.

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“…Pour Neuville et al, il existait un différence significative entre le groupe contrôle et le groupe anticoagulation en terme de durée de séjour (2 jours vs 4,4 jours ; p=0,01), durée d'irrigation (0,9 jours vs 1,8 jours ; p=0,01) ainsi qu'en durée de sondage (1,6 jours vs 3,5 jours ; p=0,01) [17]. Dans une étude plus récente, Becker et al ont analysé les résultats de l'HoLEP chez 94 patients avec une anticoagulation orale et 151 sous anti vitamine K [18]. La durée d'hospitalisation était également plus longue, en moyenne 5,2 jours pour le groupe AVK, 5,3 jours pour le groupe anticoagulation orale contre 4,5 jours dans le groupe controle.…”

Section: Discussionunclassified

Impact des anticoagulants et antiagrégants sur complications hémorragiques chez les patients traités par HoLEP

Branchu

León

Fournier

et al. 2020

Progrès en Urologie

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Perioperative Safety in Patient Under Oral Anticoagulation During Holmium Laser Enucleation of the Prostate

Cited by 24 publications

References 27 publications

Assessing the Outcome of Holmium Laser Enucleation of the Prostate by Age, Prostate Volume, and a History of Blood Thinning Agents: Report from a Single-Center Series of >1800 Consecutive Cases

Assessing the Outcome of Holmium Laser Enucleation of the Prostate by Age, Prostate Volume, and a History of Blood Thinning Agents: Report from a Single-Center Series of >1800 Consecutive Cases

Holmium laser enucleation of the prostate: efficacy, safety and preoperative management in patients presenting with anticoagulation therapy

Impact des anticoagulants et antiagrégants sur complications hémorragiques chez les patients traités par HoLEP

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