Bleeding-related outcomes after transurethral resection of prostate in patients with chronic antiplatelet or anticoagulant therapy following perioperative interruption: a retrospective cohort study.

Abstract

Background: Transurethral resection of the prostate (TURP) is s the gold standard surgical treatment method for benign prostatic hyperplasia. With the aging population and the increasing prevalence of cardiovascular diseases, the number of patients requiring anticoagulant (AC) or antiplatelet (AP) therapy continues to rise. The perioperative management of these medications remains challenging because continuation may increase bleeding complications, whereas discontinuation may increase thromboembolic risk. In this study, we evaluated bleeding-related outcomes after TURP in patients receiving chronic AP or AC therapy undergoing perioperative medication interruption.

Methods: This retrospective study included patients who underwent TURP between January 2020 and December 2024 at our tertiary referral center. Patients were divided into three groups according to their perioperative use of AP and AC medications.

Control group: Patients who did not receive any AC or AP therapy. AP group: Patients receiving antiplatelet therapy. AC group: Patients treated with anticoagulants. None of the patients underwent TURP under continued AP or AC therapy. Perioperative and postoperative outcomes, including duration of irrigation, duration of catheterization, length of hospital stay, development of clot retention during hospitalization, need for postoperative blood transfusion, readmission due to hematuria within 30 days, and need for recatheterization or reoperation due to bleeding, were evaluated. A composite bleeding outcome was created to increase statistical power including postoperative blood transfusion, clot retention, and hematuria-related readmission.

Results: A total of 325 patients were included: 198 in the control group, 97 in the AP group, and 30 in the AC group. Overall comparisons showed significant differences in postoperative transfusion (p = 0.001) and hematuria-related readmission rates (p = 0.032) between three groups but post-hoc pairwise Fisher's exact tests with Bonferroni correction did not confirm statistical significance between specific pairs. There were no significant differences between the groups in other parameters. Multivariable logistic regression identified antiplatelet therapy as an independent predictor of hematuria-related readmission (OR:4.17, p = 0.010).

Conclusion: AP therapy is independently associated with an increased risk of hematuria-related readmission even after perioperative interruption of therapy. Patients receiving antithrombotic therapy should be carefully monitored during the perioperative period, and clinicians should remain vigilant for potential bleeding-related complications.