Perioperative antithrombotic (antiplatelet and anticoagulant) therapy in urological practice: a critical assessment and summary of the clinical practice guidelines

Abstract

Purpose:The perioperative management of patients who are receiving antithrombotic (antiplatelet or anticoagulant) therapy and require urologic surgery is challenging due to the inherent risk for surgical bleeding and the need to minimize thromboembolic risk. The aim of this review is to assess the quality and consistency of clinical practice guidelines (CPGs) and clinical practice recommendations (CPRs) on this topic, and to summarize the evidence and associated strength of recommendations relating to perioperative antithrombotic management. Methods: A pragmatic search of electronic databases and guidelines websites was performed to identify relevant CPGs/CPRs. The AGREE II (Appraisal of Guidelines for REsearch and Evaluation) instrument was used to assess the methodological quality and integrity of the CPGs. Results: The CPGs provided by the European Association of Urology (EAU), the American College of Chest Physicians (ACCP) and the European Society of Cardiology/European Society of Anaesthesiology (ESC/ESA), and the CPRs provided by the International Consultation on Urological Disease (ICUD)/American Urologic Association (AUA) were retrieved and reviewed. The 3 CPGs were critically assessed using the AGREE II instrument. Inconsistent recommendations were provided based on the indication for antithrombotic medication, the antiplatelet/anticoagulant agent and the type of urological procedure. Based on the AGREE II tool for CPG assessment, the EAU CPGs scored higher (83.3 points) compared to the ESC/ESA (75 points) and ACCP CPG (66.7 points). Conclusion:The perioperative management of antithrombotic therapy in urological patients is potentially challenging but inconsistent CPG of varying quality may create uncertainty as to best practices to minimize thromboembolic and bleeding risk.

Role of Folic Acid Drugs in the Treatment with Antithrombotic and Anticoagulant Drugs for Patients with Cardiovascular Diseases Based on the Analysis of Virtual Reality Medical Data

“…In these cases, long-term stable and uninterrupted monitoring is required. Long-term stable monitoring is also needed to prevent the irreversible trauma caused by sudden outbreaks to the human body [ 18 , 19 ]. If long-term monitoring of the abovementioned patients can be achieved, it will not only dig out the deep-seated pathology of the patients to facilitate targeted treatment, but, at the same time, it is also very helpful for urgent treatment of diseases, because actually the best treatment period for these diseases is at the beginning of the outbreak.…”

Venous Thromboembolism and Bleeding after Transurethral Resection of the Prostate (TURP) in Patients with Preoperative Antithrombotic Therapy: A Single-Center Study from a Tertiary Hospital in China

“…The European Association of Urology (EAU) recommends that the timing of preoperative discontinuation of antithrombotic drugs in non-extremely high-risk patients should be adjusted according to the type of antithrombotic drug, ranging from 12 h before surgery (e.g., for unfractionated heparin) to 5–7 days (e.g., for clopidogrel) [ 25 ]. Dimitropoulos K et al [ 12 ] suggested that oral antithrombotic therapy should be discontinued 7–10 days before TURP in patients with low risk of cardiovascular events. There is relatively much literature in this field regarding the effect of preoperative discontinuation of antithrombotic drugs on postoperative bleeding after TURP [ 14 , 26 , 27 , 28 ].…”

“…The timing of preoperative discontinuation of antithrombotic drugs is critical. However, the existing studies [ 11 , 12 ] mostly focus on the influence of stopping time on postoperative hemorrhage risk and fail to comprehensively assess the risk of hemorrhage and VTE. In addition, most studies [ 13 , 14 , 15 ] only analyzed the effect of aspirin on TURP surgery, which is difficult to fully adapt to the actual complex clinical situation.…”

Clinical practice guidelines for management of dual antiplatelet therapy in patients with noncardiac surgery: A critical appraisal using the AGREE II instrument

“…In this study, a comprehensive literature search was performed. Compared with another recent paper addressing perioperative antithrombotic therapy in urological practice, 26 we had the following distinctions. First, we attempted to collect all information related to the guideline development process through carefully reading guideline documents, appendices and methodological manuals, and we included ten CPGs addressing the perioperative management of DAPT in patients with coronary stents who needed elective noncardiac surgery.…”