Transperineal ultrasound-guided prostate biopsy is safe even when patients are on combination antiplatelet and/or anticoagulation therapy

Abstract

BackgroundTo assess whether hemorrhagic complications associated with transperineal prostate biopsy increased in patients on antiplatelet and/or anticoagulant therapy.MethodsIn 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.ResultsOf 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.ConclusionNo 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.

Prostate Fiducial Marker Placement in Patients on Anticoagulation: Feasibility Prior to Prostate SBRT

“…While Saito et al analogously found comparable bleeding risk in patients on anticoagulant or antiplatelet therapy and those who were not, patients on these medications were more likely to have clot retention and minor bleeding following biopsy. Notably, there was no report of significant bleeding events in any patient undergoing transrectal ultrasound guided biopsy (13,14). While this is the first study to suggest that chronic antiplatelet or anticoagulant medication is not an absolute contraindication for seed placement, further research is required.…”

Prostate interventions in patients with mild haemophilia: Safe and feasible

“…Some authors have suggested a benefit for trans-perineal biopsies with fewer bleeding complications in patients on active anticoagulation therapy. 18 Trans-perineal biopsies in PWH should be assessed in the future.…”

“…Regarding the low incidence of bleeding complications, it seems reasonable to drop the hospital admission duration to a single post‐operative night and to continue the treatment at home to maintain normal FVIII: C levels for 5‐7 days. Some authors have suggested a benefit for trans‐perineal biopsies with fewer bleeding complications in patients on active anticoagulation therapy 18 . Trans‐perineal biopsies in PWH should be assessed in the future.…”

Safety of transrectal ultrasound-guided prostate biopsy in patients receiving aspirin

“…Saito et al performed a comparative study that included 598 patients who underwent a TPUS-PB. [ 20 ] The results indicated that even though the medication group exhibited an increased bleeding risk, which was minor, it was not necessary to discontinue the use of anticoagulant or antiplatelet agents. Asano et al reported that the incidence of bleeding between group of patients who continued to use antithrombotic during TPUS-PB and a control group did not exhibit any significant differences.…”