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Wang TF, Sanfilippo KM, Douketis J, Falanga A, Karageorgiou J, Maraveyas A, Ortel TL, Soff G, Vedantham S, Zwicker JI. Peri-procedure management of antithrombotic agents and thrombocytopenia for common procedures in oncology: Guidance from the SSC of the ISTH. J Thromb Haemost 2022; 20:3026-3038. [PMID: 36217296 DOI: 10.1111/jth.15896] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/31/2022] [Accepted: 09/23/2022] [Indexed: 01/13/2023]
Abstract
Patients with cancer have an increased risk of thrombosis requiring anticoagulants and/or antiplatelet agents, and they can also encounter thrombocytopenia due to cancer itself or cancer therapies. They often undergo many procedures such as tissue or bone marrow biopsies, placement of central access lines, diagnostic or therapeutic draining procedures, lumbar puncture, and more. Management of antithrombotic agents or thrombocytopenia around the time of these procedures is highly variable. In this document, the Hemostasis and Malignancy Subcommittee of the International Society on Thrombosis and Haemostasis aims to provide useful practice guidance in the management of antithrombotic agents and thrombocytopenia around the time of common procedures in patients with cancer.
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Affiliation(s)
- Tzu-Fei Wang
- Department of Medicine, University of Ottawa at The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kristen M Sanfilippo
- Division of Hematology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - James Douketis
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Anna Falanga
- Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - John Karageorgiou
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | | | - Thomas L Ortel
- Division of Hematology, Department of Medicine, Duke University, Durham, North Carolina, USA
- Department of Pathology, Duke University, Durham, North Carolina, USA
| | - Gerald Soff
- Division of Hematology, University of Miami Health System/Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Suresh Vedantham
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Jeffrey I Zwicker
- Division of Hemostasis and Thrombosis, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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Chen D, Liu G, Xie Y, Chen C, Luo Z, Liu Y. Safety of transrectal ultrasound-guided prostate biopsy in patients receiving aspirin: An update meta-analysis including 3373 patients. Medicine (Baltimore) 2021; 100:e26985. [PMID: 34449467 PMCID: PMC8389937 DOI: 10.1097/md.0000000000026985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 07/27/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The management of aspirin before transrectal prostate puncture-guided biopsy continues to be controversial. The conclusions in newly published studies differ from the published guideline. Therefore, an updated meta-analysis was performed to assess the safety of continuing to take aspirin when undergoing a transrectal ultrasound-guided prostate biopsy (TRUS-PB). METHODS We searched the following databases for relevant literature from their inception to October 30, 2020: PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Medline, Web of Science, Sinomed, Chinese National Knowledge Internet, and WANGFANG. Studies that compared the bleeding rates between aspirin that took aspirin and non-aspirin groups were included. The quality of all included studies was evaluated using the Newcastle-Ottawa Scale. Revman Manger version 5.2 software was employed to complete the meta-analysis to assess the risk of hematuria, hematospermia, and rectal bleeding. RESULTS Six articles involving 3373 patients were included in this meta-analysis. Our study revealed that compared with the non-aspirin group, those taking aspirin exhibited a higher risk of rectal bleeding after TRUS-PB (risk ratio [RR] = 1.27, 95% confidence interval [CI] [1.09-1.49], P = .002). Also, the meta-analysis results did not reveal any significant difference between the 2 groups for the risk of hematuria (RR = 1.02, 95%CI [0.91-1.16], P = .71) and hematospermia (RR = 0.93, 95%CI [0.82-1.06], P = .29). CONCLUSION Taking aspirin does not increase the risk of hematuria and hematospermia after TRUS-PB. However, the risk of rectal bleeding, which was slight and self-limiting, did increase. We concluded that it was not necessary to stop taking aspirin before undergoing TRUS-PB.
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Affiliation(s)
- Di Chen
- Department of Surgery, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, Guangxi, China
| | - Gang Liu
- The Reproductive Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Yurun Xie
- Department of Urology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Changsheng Chen
- Department of Urology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Zhihua Luo
- Department of Urology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Yujun Liu
- Department of Surgery, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, Guangxi, China
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Emergent cholecystectomy in patients on antithrombotic therapy. Sci Rep 2020; 10:10122. [PMID: 32572122 PMCID: PMC7308317 DOI: 10.1038/s41598-020-67272-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 06/05/2020] [Indexed: 12/20/2022] Open
Abstract
The Tokyo Guidelines 2018 (TG18) recommend emergent cholecystectomy (EC) for acute cholecystitis. However, the number of patients on antithrombotic therapy (AT) has increased significantly, and no evidence has yet suggested that EC should be performed for acute cholecystitis in such patients. The aim of this study was to evaluate whether EC is as safe for patients on AT as for patients not on AT. We retrospectively analyzed patients who underwent EC from 2007 to 2018 at a single center. First, patients were divided into two groups according to the use of antithrombotic agents: AT; and no-AT. Second, the AT group was divided into three sub-groups according to the use of single antiplatelet therapy (SAPT), double antiplatelet therapy (DAPT), or anticoagulant with or without antiplatelet therapy (AC ± APT). We then evaluated outcomes of EC among all four groups. The primary outcome was 30- and 90- day mortality rate, and secondary outcomes were morbidity rate and surgical outcomes. A total of 478 patients were enrolled (AT, n = 123, no-AT, n = 355) patients. No differences in morbidity rate (6.5% vs. 3.7%, respectively; P = 0.203), 30-day mortality rate (1.6% vs. 1.4%, respectively; P = 1.0) or 90-day mortality rate (1.6% vs. 1.4%, respectively; P = 1.0) were evident between AT and no-AT groups. Between the no-AT and AC ± APT groups, a significant difference was seen in blood loss (10 mL vs. 114 mL, respectively; P = 0.017). Among the three AT sub-groups and the no-AT group, no differences were evident in morbidity rate (3.7% vs. 8.9% vs. 0% vs. 6.5%, respectively; P = 0.201) or 30-day mortality (1.4% vs. 0% vs. 0% vs. 4.3%, respectively; P = 0.351). No hemorrhagic or thrombotic morbidities were identified after EC in any group. In conclusion, EC for acute cholecystitis is as safe for patients on AT as for patients not on AT.
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Tanabe K, Hattori T, Kobayashi H, Koike K, Maki Y, Arai T, Otsuka T, Suzuki Y, Kondo Y, Kawamura N. Is it safe to continue antithrombotic agents before prostate biopsy? Prostate Int 2019; 7:78-81. [PMID: 31384610 PMCID: PMC6664272 DOI: 10.1016/j.prnil.2018.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/06/2018] [Accepted: 06/29/2018] [Indexed: 11/19/2022] Open
Abstract
Background Whether antithrombotic agents should be stopped before prostate biopsy is unsettled. We investigated the impact of antithrombotic agents on bleeding complications after prostate biopsy. Materials and methods Among the patients who underwent transrectal ultrasound-guided prostate biopsy from June 2006 to December 2013 at Ebina General Hospital, Kanagawa, Japan, 1817 cases were retrospectively assessed. Patients were divided into two groups: those not taking antithrombotic agents (control group) and those taking them (experimental group). The frequency and severity of bleeding complications after the procedure were compared. The severity of bleeding events was graded using the Common Terminology Criteria for Advanced Events vol. 4.0. Results Hemorrhagic complications were classified into grades 1 to 3. Patients with complications of Grade 2 and above needed treatment. As for the Grade 1 event, there were no differences between two groups. The frequency of more than Grade 2 bleeding events was 1.7% and 3.5% in the control and experimental group, respectively; the odds ratio was 2.18 (P = 0.039). Grade 3 events occurred in seven patients of the control group (0.5%) and four patients of the experimental group (1.2%). Conclusions The present study showed that continuation of antithrombotic agents increased the frequency of hemorrhagic complications requiring intervention. It suggests that attention should be paid to the patients taking antithrombotic agents before prostate biopsy.
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Key Words
- AA, antithrombotic agent
- AC, anticoagulant agent
- AP, antiplatelet agent
- ASA, acetylsalicylic acid
- Anticoagulants
- Biopsy
- Hemorrhage
- MAP, major antiplatelet agent
- OR, odds ratio
- PSA, prostate-specific agent
- Platelet aggregation inhibitors
- Prostate
- RR, relative risk
- SD, standard deviation
- TE, thromboembolism
- TPV, total prostate volume
- TRUS, transrectal ultrasound
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Affiliation(s)
- Kuniaki Tanabe
- Department of Urology, Nippon Medical School, Tokyo, Japan
| | - Tomotaka Hattori
- Department of Urology, Ebina General Hospital, Kanagawa, Japan
- Corresponding author. 1320 Kawaharaguchi, Ebinashi, Kanagawa 243-0433, Japan.
| | | | - Kyoko Koike
- Department of Urology, Ebina General Hospital, Kanagawa, Japan
| | - Yasuhiro Maki
- Department of Urology, Ebina General Hospital, Kanagawa, Japan
| | - Takashi Arai
- Department of Urology Kitakyushu General Hospital, Fukuoka, Japan
| | - Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan
| | - Yasutomo Suzuki
- Department of Urology, Nippon Medical School Chiba Hokusou Hospital, Chiba, Japan
| | - Yukihiro Kondo
- Department of Urology, Nippon Medical School, Tokyo, Japan
| | - Naoki Kawamura
- Department of Urology, Ebina General Hospital, Kanagawa, Japan
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Quinlan MR, Bolton D, Casey RG. The management of rectal bleeding following transrectal prostate biopsy: A review of the current literature. Can Urol Assoc J 2017; 12:E146-E153. [PMID: 29283091 DOI: 10.5489/cuaj.4660] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Since the advent of prostate-specific antigen (PSA)-based testing, transrectal ultrasound (TRUS)-guided prostate biopsy has become a standard part of the diagnostic pathway for prostate cancer (PCa). Rectal bleeding is one of the common side effects of this transrectal route. While rectal bleeding is usually mild and self-limiting, it can be life-threatening. In this article, we examine rectal bleeding post-TRUS-guided prostate biopsy and explore the literature to evaluate techniques and strategies aimed at preventing and managing this common and important complication. METHODS A PubMed literature search was carried out using the keywords "transrectal-prostate-biopsy-bleed." A search of the bibliography of reviewed studies was also conducted. Additionally, papers in non-PubMed-listed journals of which the authors were aware were appraised. RESULTS Numerous modifiable risk factors for this bleeding complication exist, particularly anticoagulants/antiplatelets and the number of core biopsies taken. Successfully described corrective measures for such rectal bleeding include tamponade (digital/packs/catheter/tampon/condom), endoscopic sclerotherapy/banding/clipping, radiological embolization, and surgical intervention. CONCLUSIONS We advocate early consultation with the colorectal/gastroenterology and interventional radiology services and a progressive, stepwise approach to the management of post-biopsy rectal bleeding, starting with resuscitation and conservative tamponade measures, moving to endoscopic hemostasis ± radiological embolization ± transanal surgical methods. Given the infrequent but serious nature of major rectal bleeding after TRUS biopsy, we recommend the establishment of centralized databases or registries forthwith to prospectively capture such data. To the best of our knowledge, this is the first comprehensive look specifically at the management of post-TRUS biopsy rectal bleeding.
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Affiliation(s)
- Mark R Quinlan
- Department of Urology, Austin Hospital, Heidelberg, Melbourne, Australia
| | - Damien Bolton
- Department of Urology, Austin Hospital, Heidelberg, Melbourne, Australia
| | - Rowan G Casey
- Department of Urology, Colchester Cancer Centre, Colchester NHS University Foundation Trust, Essex, United Kingdom
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Saito K, Washino S, Nakamura Y, Konishi T, Ohshima M, Arai Y, Miyagawa T. Transperineal ultrasound-guided prostate biopsy is safe even when patients are on combination antiplatelet and/or anticoagulation therapy. BMC Urol 2017; 17:53. [PMID: 28679384 PMCID: PMC5499054 DOI: 10.1186/s12894-017-0245-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 06/29/2017] [Indexed: 12/05/2022] Open
Abstract
Background To assess whether hemorrhagic complications associated with transperineal prostate biopsy increased in patients on antiplatelet and/or anticoagulant therapy. Methods In total, 598 consecutive patients underwent transperineal prostate biopsy. The medication group comprised patients who took anti-thromboembolic agents, and the control group comprised those who did not take these agents. No anti-thromboembolic agent was stopped before, during, or after prostate biopsy in the medication group. Complications developing in both groups were compared and classified using the modified Clavien classification system. Subgroup analyses to compare complications in patients taking single antiplatelet, single anticoagulant, and dual antiplatelet and/or anticoagulant agents, and multivariate analyses to predict bleeding risk were also performed. Results Of the 598 eligible patients, 149 comprised the medication group and 449 comprised the control group. Hematuria (Grade I) developed in 88 (59.1%) and 236 (52.5%) patients in the medication and control group, respectively (p = 0.18). Clot retention (Grade I) was more frequently observed in the medication group than the controls (2.0% versus 0.2%, respectively, p < 0.05). Hospitalization was more frequently prolonged in the medication than the control group (4.0% versus 0.4% of patients, respectively). No complication of Grade III or higher developed in either group. Hematuria was more frequent in patients taking a single anticoagulant (p = 0.007) or two anti-thromboembolic agents (p = 0.04) compared with those taking a single antiplatelet agent. Other complications were generally similar among the groups. In the multivariate analysis, taking more than two anti-thromboembolic agents was the only significant risk factor for bleeding events. Conclusion No severe complication developed after the transperineal biopsies in either group, although minor bleeding was somewhat more frequent in the medication group. It may not be necessary to discontinue anticoagulant and/or antiplatelet agents when transperineal prostate biopsy is contemplated.
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Affiliation(s)
- Kimitoshi Saito
- Department of Urology, Jichi Medical University Saitama Medical Center, 1-847, Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan.
| | - Satoshi Washino
- Department of Urology, Jichi Medical University Saitama Medical Center, 1-847, Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan
| | - Yuhki Nakamura
- Department of Urology, Jichi Medical University Saitama Medical Center, 1-847, Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan
| | - Tsuzumi Konishi
- Department of Urology, Jichi Medical University Saitama Medical Center, 1-847, Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan
| | - Masashi Ohshima
- Department of Urology, Jichi Medical University Saitama Medical Center, 1-847, Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan
| | - Yoshiaki Arai
- Department of Urology, Nishi-Omiya Hospital, 1-1173, Mihashi, Omiya-ku, Saitama, 330-0856, Japan
| | - Tomoaki Miyagawa
- Department of Urology, Jichi Medical University Saitama Medical Center, 1-847, Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan
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Park BH, Kim JI, Bae SR, Lee YS, Kang SH, Han CH. The effect of ultrasound-guided compression immediately after transrectal ultrasound-guided prostate biopsy on postbiopsy bleeding: a randomized controlled pilot study. Int Urol Nephrol 2017; 49:1319-1325. [PMID: 28474311 DOI: 10.1007/s11255-017-1607-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 04/28/2017] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate whether ultrasound-guided compression performed immediately after transrectal ultrasound (TRUS)-guided prostate biopsy decreases bleeding complications. METHODS We prospectively evaluated a total of 148 consecutive patients who underwent TRUS-guided prostate biopsy between March 2015 and July 2016. Systematic 12-core prostate biopsy was performed in all patients. Of these, 100 patients were randomly assigned to one of two groups: the compression group (n = 50) underwent TRUS-guided compression on bleeding biopsy tracts immediately after prostate biopsy, while the non-compression group (n = 50) underwent TRUS-guided prostate biopsy alone. The incidence rate and duration of hematuria, hematospermia, and rectal bleeding were compared between the two groups. RESULTS The incidence rates of hematuria and hematospermia were not significantly different between the two groups (60 vs. 64%, p = 0.68; 22 vs. 30%, p = 0.362, respectively, for compression vs. non-compression group). The rectal bleeding incidence was significantly lower in the compression group as compared to the non-compression group (20 vs. 44%, p = 0.01). However, there were no significant differences in the median duration of hematuria, hematospermia, or rectal bleeding between the two groups (2, 8, and 2 days vs. 2, 10, and 1 days, p > 0.05, respectively, for compression vs. non-compression group). TRUS-guided compression [p = 0.004, odds ratio (OR) 0.25] and patient age (p = 0.013, OR 0.93) were significantly protective against the occurrence of rectal bleeding after prostate biopsy in multivariable analysis. CONCLUSIONS Although it has no impact on other complications, ultrasound-guided compression on bleeding biopsy tracts performed immediately after TRUS-guided prostate biopsy is an effective and practical method to treat or decrease rectal bleeding.
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Affiliation(s)
- Bong Hee Park
- Department of Urology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #271, Cheon Bo-Ro, Uijeongbu, Gyeonggi-Do, Republic of Korea
| | - Jung Im Kim
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Sang Rak Bae
- Department of Urology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #271, Cheon Bo-Ro, Uijeongbu, Gyeonggi-Do, Republic of Korea
| | - Yong Seok Lee
- Department of Urology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #271, Cheon Bo-Ro, Uijeongbu, Gyeonggi-Do, Republic of Korea
| | - Sung Hak Kang
- Department of Urology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #271, Cheon Bo-Ro, Uijeongbu, Gyeonggi-Do, Republic of Korea
| | - Chang Hee Han
- Department of Urology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #271, Cheon Bo-Ro, Uijeongbu, Gyeonggi-Do, Republic of Korea.
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Vasudeva P, Kumar N, Kumar A, Singh H, Kumar G. Safety of 12 core transrectal ultrasound guided prostate biopsy in patients on aspirin. Int Braz J Urol 2016; 41:1096-100. [PMID: 26742966 PMCID: PMC4756934 DOI: 10.1590/s1677-5538.ibju.2015.0053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 07/27/2015] [Indexed: 11/22/2022] Open
Abstract
Objective: To prospectively assess safety outcome of TRUS guided prostate biopsy in patients taking low dose aspirin. Materials and methods: Consecutive patients, who were planned for 12 core TRUS guided prostate biopsy and satisfied eligibility criteria, were included in the study and divided into two Groups: Group A: patients on aspirin during biopsy, Group B: patients not on aspirin during biopsy, including patients in whom aspirin was stopped prior to the biopsy. Parameters included for statistical analysis were: age, serum prostate specific antigen (PSA), prostate volume, hemoglobin (Hb %), number of hematuria episodes, number of patient reporting hematuria, hematuria requiring intervention, number of patient reporting hematospermia and number of patient reporting rectal bleeding. Results: Of 681 eligible patients, Group A and B had 191 and 490 patients respectively. The mean age, prostate volume, serum PSA and pre-biopsy hemoglobin were similar in both Groups with no significant differences noted between them. None of the post-biopsy complications, including number of hematuria episodes (p=0.83), number of patients reporting hematuria (p=0.55), number of patients reporting hematospermia (p=0.36) and number of patients reporting rectal bleeding (p=0.65), were significantly different between Groups A and B respectively. None of the hemorrhagic complication in either group required intervention and were self limiting. Conclusion: Continuing low dose aspirin during TRUS guided prostate biopsy neither alters the minor bleeding episodes nor causes major bleeding complication. So, discontinuation of low dose aspirin prior to TRUS guided prostate biopsy is not required.
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Affiliation(s)
- Pawan Vasudeva
- Department of Urology, V.M. Medical College and Safdarjang Hospital, New Delhi 110029, India
| | - Niraj Kumar
- Department of Urology, V.M. Medical College and Safdarjang Hospital, New Delhi 110029, India
| | - Anup Kumar
- Department of Urology, V.M. Medical College and Safdarjang Hospital, New Delhi 110029, India
| | - Harbinder Singh
- Department of Urology, V.M. Medical College and Safdarjang Hospital, New Delhi 110029, India
| | - Gaurav Kumar
- Department of Urology, V.M. Medical College and Safdarjang Hospital, New Delhi 110029, India
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Hsueh WD, Hwang PH, Abuzeid WM. Perioperative Management of Antithrombotic Therapy in Common Otolaryngologic Surgical Procedures: State of the Art Review. Otolaryngol Head Neck Surg 2015; 153:493-503. [PMID: 26307580 DOI: 10.1177/0194599815600409] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 07/23/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The perioperative management of patients undergoing otolaryngologic procedures is increasingly complicated by the use of newer antithrombotic agents. Furthermore, with advances in anesthesia and surgical technique, otolaryngologists are presented with the challenge of operating on patients with advanced comorbid diseases. The objective of this review is to provide evidence-based recommendations on perioperative antithrombotic management for common otolaryngologic procedures. DATA SOURCES PubMed/MEDLINE. REVIEW METHODS Selected literature on patient-specific thromboembolic risk, rate of bleeding complications in otolaryngologic procedures, and the interruption of antithrombotic therapy is reviewed and interpreted by expert opinion. CONCLUSIONS By stratifying patients into either low thromboembolic risk (≤ 5%) or high thromboembolic risk (> 5%) and interpreting this in the context of procedural bleed risk and potential clinical consequences in the event of a bleed, otolaryngologists can make evidence-based decisions to determine the appropriate perioperative management of antithrombotic therapy. IMPLICATIONS FOR PRACTICE When the perioperative management of antithrombotic therapy is being decided, 3 critical factors must be considered systematically: the patient's inherent thromboembolic risk, the risk and potential consequences of bleeding related to the procedure, and the timing of interruption of thromboembolic therapy.
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Affiliation(s)
- Wayne D Hsueh
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Waleed M Abuzeid
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, USA
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Nayak-Rao S. Percutaneous native kidney biopsy in patients receiving antiplatelet agents- is it necessary to stop them routinely? Indian J Nephrol 2015; 25:129-32. [PMID: 26060359 PMCID: PMC4446914 DOI: 10.4103/0971-4065.147374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Percutaneous renal biopsy plays an important role in the investigational approach of the nephrologist. Though the technique and the safety of the procedure has improved over the last two decades it remains an invasive procedure and can be associated with bleeding complications. To minimize the risk of bleeding, it has been the practice of many centers and nephrologists to advise patients receiving antiplatelet agents to discontinue them 5-7 days before planned procedure. This advice is based on opinion and pre-established procedure or norms rather than sound evidence based guidelines. This article aims to be a critical appraisal of this unnecessary and sometimes not so safe practice of routine stoppage of antiplatelet agents prior to kidney biopsy.
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Affiliation(s)
- S Nayak-Rao
- Consultant Nephrologist, Sri Krishna Sevashrama Hospital, Bengaluru, Karnataka, India
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Asano T, Kobayashi S, Yano M, Otsuka Y, Kitahara S. Continued administration of antithrombotic agents during transperineal prostate biopsy. Int Braz J Urol 2015; 41:116-23. [PMID: 25928517 PMCID: PMC4752064 DOI: 10.1590/s1677-5538.ibju.2015.01.16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 06/26/2014] [Indexed: 11/22/2022] Open
Abstract
Purpose To determine the safety of continued administration of antithrombotic agents during transperineal (TP) prostate biopsy. Patients and Methods A total of 811 men who underwent transrectal ultrasound (TRUS)-guided TP biopsy from January 2008 to June 2012 at our two institutions were retrospectively analyzed. Among these 811 men, 672 received no antithrombotic agents (group I), 103 received and continued administration of antithrombotic agents (group II), and 36 interrupted administration of antithrombotic agents (group III). Overall complications were graded and hemorrhagic complications were compared (group I with group II) using propensity score matching (PSM) analysis. Results An overall complication rate of 4.6% was recorded. Hemorrhagic complications occurred in 1.8% and they were virtually identical in all the three groups, and no severe hemorrhagic complications occurred. One patient in group III required intensive care unit admission for cerebral infarction. PSM analysis revealed no statistical difference between groups I and II with regard to the incidence of gross hematuria, perineal hematoma, and rectal bleeding. Multiple regression analysis revealed that hemorrhagic complications were associated with lower body mass index (<21 kg/m2, P=0.0058), but not with administration of antithrombotic agents. Conclusions Continued administration of antithrombotic agents does not increase the risk of hemorrhagic complications; these agents are well tolerated during TP biopsy.
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Affiliation(s)
- Toko Asano
- Service of Urology, Omori Red Cross Hospital, Tokyo, Japan
| | | | - Masataka Yano
- Service of Urology, Tama-Nambu Chiiki Hospital, Tokyo, Japan
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Fiducial marker implantation in prostate radiation therapy: complication rates and technique. Cancer Radiother 2014; 18:736-9. [PMID: 25451675 DOI: 10.1016/j.canrad.2014.07.160] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 07/02/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE This study aims to report the complication rate from the transrectal ultrasound-guided implantation of gold seed markers in prostate radiotherapy, as well as describing the technique used. MATERIALS AND METHODS Between May 2010 and December 2012, 169 patients with localized prostate cancer had an intraprostatic fiducial marker implantation under transrectal ultrasound guidance. The procedure included prophylactic antibiotic therapy, fleet enema, implantation performed by trained radiation oncologists at our center prior to image-guided radiotherapy. Toxicity occurring between implantation and subsequent radiotherapy start date was assessed. The following parameters were analyzed via medical chart review: antibiotic therapy, anticoagulant interruption, bleeding, pain, prostate volume, number of markers implanted, post-implantation complications and delay before starting radiotherapy. RESULTS Of the 169 men, 119 (70.4%) underwent insertion of 4 fiducial markers and the other 50 (29.6%) had 3. The procedure was well-tolerated. There was no interruption of the implantation with regards to pain or hemorrhage. No grade 3 or 4 complications were observed. Seed migration rate was 0.32%, for the migration of 2 markers on 626 implanted. Mean prostate volume was 38 cm(3) (range: 10-150 cm(3)). Two patients (1.18%) developed a urinary tract infection following the procedure: prostate volume of 25 and 65 cm(3), four gold seed markers implanted, urinary tract infection resistant to prophylactic antibiotherapy, and treated with antibiotics specific to their infection as determined on urine culture. CONCLUSION Transrectal fiducial marker implantation for image-guided radiotherapy in prostate cancer is a well-tolerated procedure without major associated complications.
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Culkin DJ, Exaire EJ, Green D, Soloway MS, Gross AJ, Desai MR, White JR, Lightner DJ. Anticoagulation and Antiplatelet Therapy in Urological Practice: ICUD/AUA Review Paper. J Urol 2014; 192:1026-34. [DOI: 10.1016/j.juro.2014.04.103] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2014] [Indexed: 12/19/2022]
Affiliation(s)
- Daniel J. Culkin
- Health Sciences Center, University of Oklahoma, Oklahoma City, Oklahoma
| | - Emilio J. Exaire
- Health Sciences Center, University of Oklahoma, Oklahoma City, Oklahoma
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Anastasiadis A, Zapała L, Cordeiro E, Antoniewicz A, Dimitriadis G, De Reijke T. Complications of prostate biopsy. Expert Rev Anticancer Ther 2014; 13:829-37. [PMID: 23875661 DOI: 10.1586/14737140.2013.811056] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Biopsy of the prostate is a common procedure with minor complications that are usually self-limited. However, if one considers that millions of men undergo biopsy worldwide, one realizes that although complication rate is low, the number of patients suffering from biopsy complications should not be underestimated and can be a clinically relevant problem for healthcare professionals. In this review, the authors present diagnosis and management of postbiopsy of prostate complications. Bleeding is the most common complication observed after prostate biopsy, but the use of aspirin or nonsteroidal anti-inflammatory drugs is not an absolute contraindication to prostate biopsy. Emerging resistance to ciprofloxacin is the most probable cause of the increasing risk of infectious complications after prostate biopsy. Even though extremely rare, fatal complications are possible and were described in case reports.
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Affiliation(s)
- Anastasios Anastasiadis
- Department of Urology, AMC University Hospital, Meibergdreef 9,1105 Amsterdam, The Netherlands
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17
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Jin S, Wang Y, Zhu H, Wang Y, Zhao S, Zhao M, Liu J, Wu J, Gao W, Peng S. Nanosized aspirin-Arg-Gly-Asp-Val: delivery of aspirin to thrombus by the target carrier Arg-Gly-Asp-Val tetrapeptide. ACS NANO 2013; 7:7664-73. [PMID: 23931063 DOI: 10.1021/nn402171v] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Resistance and nonresponse to aspirin dramatically decreases its therapeutic efficacy. To overcome this issue, a small-molecule thrombus-targeting drug delivery system, aspirin-Arg-Gly-Asp-Val (A-RGDV), is developed by covalently linking Arg-Gly-Asp-Val tetrapeptide with aspirin. The 2D ROESY NMR and ESI-MS spectra support a molecular model of an A-RGDV tetramer. Transmission electron microscopy images suggest that the tetramer spontaneously assembles to nanoparticles (ranging from 5 to 50 nm in diameter) in water. Scanning electron microscopy images and atomic force microscopy images indicate that the smaller nanoparticles of A-RGDV further assemble to bigger particles that are stable in rat blood. The delivery investigation implies that in rat blood A-RGDV is able to keep its molecular integrity, while in a thrombus it releases aspirin. The in vitro antiplatelet aggregation assay suggests that A-RGDV selectively inhibits arachidonic acid induced platelet aggregation. The mechanisms of action probably include releasing aspirin, modifying cyclic oxidase, and decreasing the expression of GPIIb/IIIa. The in vivo assay demonstrates that the effective antithrombotic dose of A-RGDV is 16700-fold lower than the nonresponsive dose of aspirin.
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Affiliation(s)
- Shaoming Jin
- College of Pharmaceutical Sciences, Capital Medical University , Beijing 100069, People's Republic of China
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18
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Picozzi S, Marenghi C, Ricci C, Bozzini G, Casellato S, Carmignani L. Risks and complications of transurethral resection of bladder tumor among patients taking antiplatelet agents for cardiovascular disease. Surg Endosc 2013; 28:116-21. [PMID: 24002913 DOI: 10.1007/s00464-013-3136-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Accepted: 07/22/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Urologists have not reached a consensus regarding the pre-, intra-, and postoperative management of patients taking antiplatelet agents. This study aimed to evaluate the clinical course of patients receiving antithrombotic monotherapy with acetylsalicylic acid (ASA) 100 mg who underwent transurethral resection of bladder cancer. METHODS This study was designed to compare the surgical outcomes for 108 transurethral resections of bladder cancer performed for patients taking antiplatelet therapy and for 105 procedures performed for patients who had never taken antiplatelet agents before surgery. Antiaggregant therapy was maintained according to criteria evaluated by a urologist, surgeon, anesthesiologist, and cardiologist. Variables were described using the mean as the location index and using standard deviation as a dispersion index if continuous percentages were used elsewhere. Group comparisons were performed using the t test or the chi-square test for categorical data, and Fisher's exact test was used where appropriate. RESULTS The mean operative time for patients taking ASA was 31 min (range 10-65 min), whereas it was 26 min (range 5-60 min) for control subjects. The difference between pre- and postoperative hemoglobin values was -0.6 g/dl in the group receiving antiplatelet therapy and -0.8 g/dl in the control group (p = 0.0720). Transfusional support was required during four procedures performed for patients taking antiplatelet therapy and during two procedures for the control group (p = 0.242). No adverse cardiac events or anesthesia-related complications occurred. Three patients in the treatment group and two patients in the control group required reintervention to ensure hemostasis during the postoperative period. None of the patients in either group underwent rehospitalization for hematuria after leaving the hospital. CONCLUSION The current results suggest that continued use of anti-aggregant monotherapy does not increase the risk of overall bleeding or reintervention for patients undergoing transurethral resection of bladder neoplasms and that suspending aspirin before such a procedure is therefore unnecessary.
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Affiliation(s)
- Stefano Picozzi
- Urology Department, IRCCS Policlinico San Donato, University of Milan, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy,
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Loeb S, Vellekoop A, Ahmed HU, Catto J, Emberton M, Nam R, Rosario DJ, Scattoni V, Lotan Y. Systematic review of complications of prostate biopsy. Eur Urol 2013; 64:876-92. [PMID: 23787356 DOI: 10.1016/j.eururo.2013.05.049] [Citation(s) in RCA: 676] [Impact Index Per Article: 61.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 05/24/2013] [Indexed: 12/11/2022]
Abstract
CONTEXT Prostate biopsy is commonly performed for cancer detection and management. The benefits and risks of prostate biopsy are germane to ongoing debates about prostate cancer screening and treatment. OBJECTIVE To perform a systematic review of complications from prostate biopsy. EVIDENCE ACQUISITION A literature search was performed using PubMed and Embase, supplemented with additional references. Articles were reviewed for data on the following complications: hematuria, rectal bleeding, hematospermia, infection, pain, lower urinary tract symptoms (LUTS), urinary retention, erectile dysfunction, and mortality. EVIDENCE SYNTHESIS After biopsy, hematuria and hematospermia are common but typically mild and self-limiting. Severe rectal bleeding is uncommon. Despite antimicrobial prophylaxis, infectious complications are increasing over time and are the most common reason for hospitalization after biopsy. Pain may occur at several stages of prostate biopsy and can be mitigated by anesthetic agents and anxiety-reduction techniques. Up to 25% of men have transient LUTS after biopsy, and <2% have frank urinary retention, with slightly higher rates reported after transperineal template biopsy. Biopsy-related mortality is rare. CONCLUSIONS Preparation for biopsy should include antimicrobial prophylaxis and pain management. Prostate biopsy is frequently associated with minor bleeding and urinary symptoms that usually do not require intervention. Infectious complications can be serious, requiring prompt management and continued work into preventative strategies.
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Affiliation(s)
- Stacy Loeb
- Department of Urology, New York University, New York, NY, USA.
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Baron TH, Kamath PS, McBane RD. Management of antithrombotic therapy in patients undergoing invasive procedures. N Engl J Med 2013; 368:2113-24. [PMID: 23718166 DOI: 10.1056/nejmra1206531] [Citation(s) in RCA: 279] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Todd H Baron
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA.
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Chowdhury R, Abbas A, Idriz S, Hoy A, Rutherford E, Smart J. Should warfarin or aspirin be stopped prior to prostate biopsy? An analysis of bleeding complications related to increasing sample number regimes. Clin Radiol 2012; 67:e64-70. [DOI: 10.1016/j.crad.2012.08.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 07/27/2012] [Accepted: 08/01/2012] [Indexed: 11/25/2022]
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22
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23
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Gupta AD, Streiff M, Resar J, Schoenberg M. REPLY. BJU Int 2012. [DOI: 10.1111/j.1464-410x.2012.10983_4.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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