Should warfarin or aspirin be stopped prior to prostate biopsy? An analysis of bleeding complications related to increasing sample number regimes

Chowdhury, Riaz; Abbas, Ali; Idriz, S.; Hoy, Andrew L. Sew; Rutherford, Elaine; Smart, J

doi:10.1016/j.crad.2012.08.005

Cited by 44 publications

(35 citation statements)

References 35 publications

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“…81,83 Similar trends demonstrating no increased risk of bleeding have been noted in evaluating the safety of continuing warfarin during biopsy. 84,85 Taken together, it appears as though aspirin may be continued during the procedure if there is any concern about the safety of withholding it. Data on stopping warfarin and clopidogrel are limited and the risks between cardiovascular or thromboembolic events when stopping anticoagulation must be weighed against the risk for bleeding and associated complications with continuation.…”

Section: Complicationsmentioning

confidence: 99%

Optimization of Prostate Biopsy

Bjurlin

Wysock

Taneja

2014

Urologic Clinics of North America

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Section: Complicationsmentioning

confidence: 99%

Optimization of Prostate Biopsy

Bjurlin

Wysock

Taneja

2014

Urologic Clinics of North America

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“…Conversely, low-dose aspirin significantly increased the incidence of hematuria, and both incidence and duration of rectal bleeding. No severe hemorrhagic complications were reported 12 . Similarly, Ihezue et al…”

Section: Use Of Anticoagulants and Bleeding Complicationsmentioning

confidence: 99%

“…Comparable results have been reported by other authors 20 . Chowdhury et al compared results of 930 men undergoing TRUS-guided PB with increasing sampling number (up to 10), without stopping warfarin or aspirin 12 . The type of bleeding complication, duration and severity significantly increased with an increasing number of cores in all patents.…”

Section: Use Of Anticoagulants and Bleeding Complicationsmentioning

confidence: 99%

Complications After Systematic, Random, and Image-guided Prostate Biopsy

et al. 2017

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Evidence Synthesis: The most frequent complication after PB is minor and self-limiting bleeding (hematuria and hematospermia), irrespective of the biopsy approach. Occurrence of rectal bleeding was comparable among traditional TRUS-guided and image-guided PB. Almost 25% of patients experience lower urinary tract symptoms, but only a few have urinary retention, with higher rates after transperineal approach. Temporary erectile dysfunction is not negligible, with a return to baseline after 1-6 months. The incidence of infective complications is being increasing, with higher rates among men with medical comorbidities and older age. Transperineal and in-bore MRI targeted biopsy may reduce the risk of severe infectious complications. Mortality after PB is uncommon, irrespective of biopsy technique. Conclusions:Complications after PB are frequent but often self-limiting. The incidence of hospitalization due to severe infections is continuously increasing. Still, a careful appraisal of 3 patient's general health status, risk factors and likelihood of antimicrobial resistance should be done before scheduling a PB. Patient Summary:In this paper we reviewed the variety and incidence of complications after prostate biopsy. Even if frequent, seldom represent a problem for the patient. The most troublesome complications are infections. In order to minimize this risk, a careful evaluation of patient's medical condition must be done before biopsy.4

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“…Several studies have suggested the safety of continuation of warfarin amid TRUS- biopsy. In the studies of Ihezue et al (2005) and Chowdhury et al (2012), no significant differences were observed in the severity of bleeding between the patients taking warfarin (36.7 and 27.9%, respectively) and the controls (60.2 and 37.0%, respectively). These results suggest that discontinuation of warfarin before TRUS biopsy is unnecessary.…”

Section: Discussionmentioning

confidence: 88%

Safety of heparin bridging therapy for transrectal ultrasound-guided prostate biopsy in patients requiring temporary discontinuation of antithrombotic agents

et al. 2016

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BackgroundSafety of heparin bridging therapy for transrectal ultrasound-guided prostate (TRUS) biopsy in patients requiring temporary discontinuation of antithrombotic therapy is unknown. This study aimed to assess the relationship between heparin bridging therapy and the incidence of complications after TRUS biopsy.MethodsFrom January 2005 to November 2015, we performed 1307 consecutive TRUS biopsies on 1134 patients in our hospital. The patients were assigned to two groups: those without heparin bridging (the control group) and those with temporary discontinuation of antithrombotic agents with heparin bridging therapy (the bridging group). A 10–12-core TRUS biopsy was performed; the patients were evaluated for bleeding-related complications.ResultsOf 1134 patients, 1109 (1281 biopsies) and 25 (26 biopsies) were assigned to the control and bridging group, respectively. Patient background did not significantly differ between the control and bridging groups, except for age, history of diabetes, cardiovascular diseases, and CHADS2 scores. Compared with the control group, the bridging group showed a significantly higher rate of complication for any complication (35 vs. 8.3%, P < 0.001), bleeding-related complications (27 vs. 4.4%), and urinary tract infection (7.7 vs. 1.2%). No thromboembolic event was observed in the present study. Multivariate logistic analysis showed that heparin bridging therapy was a significant risk factor for the incidence of any complication and bleeding-related complications.ConclusionsHeparin bridging therapy with temporal discontinuation of antithrombotic agents may increase the risk of complications after TRUS biopsy. Further, large-scale studies are required to clarify the safety of heparin bridging therapy.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-016-3610-6) contains supplementary material, which is available to authorized users.

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Should warfarin or aspirin be stopped prior to prostate biopsy? An analysis of bleeding complications related to increasing sample number regimes

Cited by 44 publications

References 35 publications

Optimization of Prostate Biopsy

Optimization of Prostate Biopsy

Complications After Systematic, Random, and Image-guided Prostate Biopsy

Safety of heparin bridging therapy for transrectal ultrasound-guided prostate biopsy in patients requiring temporary discontinuation of antithrombotic agents

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