Perioperative outcomes of ongoing antithrombotic therapy during endoscopic surgery for benign prostatic hyperplasia: a systematic review and meta-analysis of observational studies.
Carlo Giulioni, Angelo Cafarelli, Federico Falsetti et al.
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In 30 seconds
This systematic review and meta-analysis of observational studies compared perioperative outcomes in patients continuing antiplatelet or anticoagulant therapy during endoscopic surgery for benign prostatic hyperplasia with outcomes in patients not receiving antithrombotics. Across 15 studies and 6091 patients, operative time and several recovery measures were comparable. Bleeding complications were more frequent with ongoing therapy during TURP (OR 1.90, 95% CI 1.05-3.41) and enucleation (OR 2.91, 95% CI 1.71-4.93); photoselective vaporization showed comparable rates of key complications between groups.
Key findings
- Bleeding-related complications were more frequent with antithrombotic therapy during TURP (OR 1.90, 95% CI 1.05-3.41).
- During enucleation, antithrombotic use was associated with more bleeding complications (OR 2.91, 95% CI 1.71-4.93) and bleeding requiring surgical hemostasis (OR 3.69, 95% CI 1.73-7.84).
- Photoselective vaporization had comparable transfusion, hemostasis, and urinary complication rates regardless of antithrombotic therapy.
- Operative time, postoperative hemoglobin decrease, catheterization duration, and continuous bladder irrigation time were comparable across groups.
Why it matters
Perioperative management must weigh thromboembolic risk against bleeding risk when antithrombotic therapy is continued. These pooled observational findings suggest that bleeding outcomes differ by endoscopic procedure, with more complications reported for TURP and enucleation than for photoselective vaporization. This distinction can inform discussion of procedural options when interruption of antithrombotic therapy is not feasible.
What to keep in mind
The evidence comes from observational studies, so differences between treatment groups may reflect factors beyond antithrombotic use; the abstract does not report randomized comparisons.