Blood Loss in Long-Term Aspirin Users Undergoing Transurethral Prostatectomy

Ala‐Opas, Martti; Grönlund, Sari

doi:10.3109/00365599609181300

Cited by 40 publications

(33 citation statements)

References 23 publications

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“…However, in our study we did not observe any difference in postoperative bleeding events between NSAID and the control group. This is consistent with previous studies that demonstrated a low incidence of postoperative bleeding with the use of NSAIDs when compared with narcotic analgesia after TURP (8)(9)(10)(11)(12). In a meta-analysis of 1,368 patients undergoing tonsillectomy, Krishna et al reported that the incidence of postoperative bleeding was not affected by NSAID consumption (9).…”

Section: Commentssupporting

confidence: 79%

Analgesic efficacy and safety of nonsteroidal anti-inflammatory drugs after transurethral resection of prostate

et al. 2010

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Objectives: The aim of this study was to assess the analgesic efficacy and safety of nonsteroidal anti-inflammatory drugs (NSAIDs), administered as intramuscular diclofenac in comparison with intravenous paracetamol after transurethral resection of the prostate (TURP). Materials and Methods: Fifty men, aged 55 to 75 years, undergoing TURP at our hospital were included in this study. Patients were divided randomly and prospectively into two groups (25 patients in each group). Group I (NSAID) received 75 mg of diclofenac i.m. at the end of the operation followed by 75 mg of diclofenac i.m. for 24 hours (75 mg x 2 once a day = 150 mg/24 h) postoperatively. The other group (Group II) consisted of patients who received 1g/100 mL i.v. paracetamol 15 minutes twice daily as postoperative analgesia. Postoperative pain scores were evaluated at 30 minutes, 1, 2, 4 and 6 hours after administration of each analgesic, using a visual analogue scale (VAS). Furthermore, preoperative and postoperative hemoglobin (Hb) levels and hemostatic variables (bleeding time, prothrombine time and the international normalized ratio , i.e. the ratio of a patient's prothrombin time to a normal [control] sample) were recorded in all patients. Results: The pain score changes during a 4 hour period between the two groups was similar (p = 0.162). Thirty minutes after surgery, pain scores were high (> 3 cm) in both groups and without differences between groups (p = 0.11) but 6 hours after surgery, pain scores were significantly higher with paracetamol compared to diclofenac (p < 0.05). No significant difference was observed between the groups regarding the amount of resected tissue, operating time, preoperative-postoperative Hb levels and hemostatic variables. In the both groups, no patient required blood transfusion postoperatively. Conclusions: NSAIDs are not a contraindication to TURP and should be used for the control of postoperative pain if indicated.

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Section: Commentssupporting

confidence: 79%

Analgesic efficacy and safety of nonsteroidal anti-inflammatory drugs after transurethral resection of prostate

et al. 2010

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“…Based on these studies, discontinuation of ASA before the surgical intervention was recommended. Ala-Opas et al found by comparison of 40 patients under ASA versus 42 patients without oral platelet inhibition no difference in the average blood loss and thus saw no contradictions for TURP under ASA (11).…”

Section: Discussionmentioning

confidence: 99%

Perioperative platelet inhibition in transurethral interventions: TURP/TURB

et al. 2012

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ARTICLE INFO _________________________________________________________ ___________________Purpose: To determine whether transurethral surgery under platelet inhibition is a feasible procedure. Before transurethral resection of prostate (TURP) or bladder tumours (TURB), the administration of platelet-inhibiting medication is often interrupted due to possible bleeding complications. We studied the performance of TURP and TURB under the current recommendations of the American College of Chest Physicians (ACCP) on perioperative platelet inhibition. Materials and Methods: Patients assigned for transurethral intervention were preoperatively divided into the following risk groups: low, medium and high cardio-or cerebrovascular risk. In patients with a low-risk profile, acetylsalicylic acid (ASA) was discontinued. Patients of the medium risk group continued taking 100 mg of ASA. Patients of the high-risk group receiving dual platelet inhibition (ASA + clopidogrel) were not treated operatively. In total 346 patients from the low and medium risk groups underwent transurethral intervention. Results: Forty-two out of 198 TURP were performed under 100 mg of ASA. Without ASA, a significantly shorter length of stay and earlier removal of the transurethral catheter was documented. In the parameters postoperative haemorrhage and operative revision, no significant differences were observed. Thirty-two out of 148 TURB were performed under 100 mg of ASA. Regarding the length of stay, time until catheter removal, postoperative haemorrhage and operative revision, no significant differences were found under ASA. Only significantly longer continuous irrigation was documented under ASA. Conclusion: In the case of a verified indication for use of platelet inhibitors, it is possible to avoid discontinuation and the consequent increased risk of thromboembolic incidents in transurethral surgery is admissible.

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“…These early studies therefore recommended the withdrawal of non-steroidal anti-inflammatory drugs one week before TUR-P. This recommendation was challenged by studies showing no significant increase in blood loss if patients were taking aspirin [28,29]. However, a higher incidence of late bleeding with tamponade of the urinary bladder requiring emptying in the operating room was found [29].…”

Section: Hemorrhagic Risks In Urologic Surgerymentioning

confidence: 99%

“…This recommendation was challenged by studies showing no significant increase in blood loss if patients were taking aspirin [28,29]. However, a higher incidence of late bleeding with tamponade of the urinary bladder requiring emptying in the operating room was found [29]. A randomized controlled study found that patients taking 150 mg aspirin showed no difference in intraoperative hemorrhage, operation time and amount of tissue resected, but an increase in postoperative blood loss of 51% (284 ml versus 144 ml) [30].…”

Section: Hemorrhagic Risks In Urologic Surgerymentioning

confidence: 99%

Urological Surgery and Antiplatelet Drugs After Cardiac and Cerebrovascular Accidents

Eberli

Chassot²,

Sulser

et al. 2010

Journal of Urology

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Context: The perioperative management of patients under dual antiplatelet therapy after myocardial infarction, cerebrovascular event or coronary stent implantation represents an increasingly frequent issue for urologists and anaesthesiologists.Objective: To assess the current scientific evidence and propose strategies concerning the management of urologic patients under antiplatelet therapy. A Medline & PubMed search was conducted for articles related to antiplatelet therapy after myocardial infarction, coronary stents and cerebrovascular events, and to the management of aspirin and/or clopidogrel in the context of surgery.Results: Early discontinuation of antiplatelet therapy in secondary prevention is associated with a high risk of coronary thrombosis, further increased by the hypercoagulable state induced by surgery. Aspirin has recently been recommended to be a lifelong therapy. Clopidogrel is mandatory for 6 weeks after myocardial infarction and bare-metal stents, and for 12 months after drug-eluting stents. Surgery must be postponed beyond these waiting periods, or be performed under dual antiplatelet therapy, because withdrawal therapy increases 5-10 times the risk of postoperative myocardial infarction, stent thrombosis or death. The shorter the waiting periods between revascularisation and surgery, the higher is the risk of adverse cardiac events. The risk of surgical haemorrhage is increased approximately 20% by aspirin and 50% by clopidogrel. Conclusions:The present review of the literature demonstrates that the risk of coronary thrombosis when antiplatelet agents are withdrawn before surgery is generally higher than the risk of surgical haemorrhage when antiplatelet agents are upheld. However, this issue has not yet been sufficiently evaluated in urologic patients and in many instances during urologic surgery the risk of bleeding might be exceedingly dangerous. In this problematic situation, a thorough dialogue between surgeon, cardiologist and anaesthesiologist is essential to determine all risk factors and to define the best possible strategy for each individual patient.

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Blood Loss in Long-Term Aspirin Users Undergoing Transurethral Prostatectomy

Cited by 40 publications

References 23 publications

Analgesic efficacy and safety of nonsteroidal anti-inflammatory drugs after transurethral resection of prostate

Analgesic efficacy and safety of nonsteroidal anti-inflammatory drugs after transurethral resection of prostate

Perioperative platelet inhibition in transurethral interventions: TURP/TURB

Urological Surgery and Antiplatelet Drugs After Cardiac and Cerebrovascular Accidents

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