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Branchu B, Léon P, Fournier R, Lasserre T, Tambwe R, Hoquetis L, Joncour C, Larré S. [Impact of antiplatelet and anticoagulant treatments on bleeding complications in patients treated with HoLEP]. Prog Urol 2020; 30:639-645. [PMID: 32409241 DOI: 10.1016/j.purol.2020.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/10/2020] [Accepted: 04/15/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION We aimed to assess the impact of antiplatelet and anticoagulation therapy for patients undergoing HoLEP. METHODS We performed a study during the learning curve on a consecutive series of patients who underwent HoLEP surgery from 2015 to 2018. The patients were divided into 3 groups: a control group, patients with antiplatelet therapy and patients with anticoagulation therapy. RESULTS A total of 223 patients underwent HoLEP surgery during this period: 124 in the control group, 63 in the antiplatelet group and 36 in the anticoagulant group. In the anticoagulant group, we observe significant differences with the control group for the catheterization time (2.05 days vs 5.17 days; P<0.001), the hospital length of stay (1.5 nights vs 4.49 nights; P<0.001) and complications (8.9% vs 58%; P<0.001). No difference between the control and antiplatelet groups in terms of catheterization time, hospital length of stay and complications (2.05 days vs 2.68 days; 1.5 nights vs 1.6 nights) but variation in terms of complications and bleeding complications (8.9% vs 21%; P<0,001; 8.1% vs 19%; P<0,001) CONCLUSION: Our study shows that HoLEP is therefore associated with a higher risk of bleeding for patients treated with anticoagulation therapy. Complications increase morbidity with longer catheterization time, hospitalization times and higher transfusion's rates, revision surgery and readmission. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- B Branchu
- Service d'urologie, CHU de Reims, rue Cognacq-Jay, 51100 Reims, France.
| | - P Léon
- Service d'urologie, clinique Pasteur, 17200 Royan, France
| | - R Fournier
- Service d'urologie, CHU de Reims, rue Cognacq-Jay, 51100 Reims, France
| | - T Lasserre
- Service d'urologie, CHU de Reims, rue Cognacq-Jay, 51100 Reims, France
| | - R Tambwe
- Service d'urologie, CHU de Reims, rue Cognacq-Jay, 51100 Reims, France
| | - L Hoquetis
- Service d'urologie, CHU de Reims, rue Cognacq-Jay, 51100 Reims, France
| | - C Joncour
- Service d'urologie, CHU de Reims, rue Cognacq-Jay, 51100 Reims, France
| | - S Larré
- Service d'urologie, CHU de Reims, rue Cognacq-Jay, 51100 Reims, France
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Zheng X, Peng L, Cao D, Han X, Xu H, Yang L, Ai J, Wei Q. Holmium laser enucleation of the prostate in benign prostate hyperplasia patients with or without oral antithrombotic drugs: a meta-analysis. Int Urol Nephrol 2019; 51:2127-2136. [PMID: 31494858 DOI: 10.1007/s11255-019-02278-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 09/03/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND The continuous intake of antithrombotic drugs during holmium laser enucleation of the prostate (HoLEP) remains nonconsensual. We aim to pool those controversial evidence and provide practical guidance of oral antithrombotics on HoLEP for benign prostate hyperplasia (BPH). METHOD PubMed, Embase and CENTRAL database were systematically searched up to June 2019 for trials on patients with and without oral antithrombotics undergoing HoLEP. Number of events and mean value with standard deviation were, respectively, extracted for dichotomous and continuous parameters. Subgroup analyses of anticoagulation and antiplatelet were also performed. All statistical analyses were conducted with Review Manager v.5.3 software. Newcastle-Ottawa Scale (NOS) was used to assess the quality of selected trials. RESULT Nine studies with 5528 patients were eventually selected, and patients included were generally older than 65 years. It revealed that the non-antithrombotic group had a lower rate of blood transfusion (OR 0.21, 95% CI 0.10-0.45, P < 0.0001), bladder tamponade (OR 0.30, 95% CI 0.13-0.69, P = 0.004) and acute urine retention (OR 0.52, 95% CI 0.30-0.89, P = 0.02). Operation time was also shorter (MD - 10.31, 95% CI - 12.76 to - 7.85, P < 0.00001) in the non-antithrombotic group, but the heterogeneity was considerable (I2 = 75%). Subgroup analyses were generally consistent with the primary analysis except the non-anticoagulation and anticoagulation group having similar operation time (MD 6.66, 95% CI - 7.15 to 20.48, P = 0.34). CONCLUSION The current study confirmed that continuous intake of antithrombotic drugs could significantly increase the risk of bleeding and blood transfusion, bladder tamponade and acute urine retention.
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Affiliation(s)
- Xiaonan Zheng
- West China Medical School, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Liao Peng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Dehong Cao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xin Han
- West China Medical School, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Hang Xu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Lu Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jianzhong Ai
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China.
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