Bleeding risk of blood thinners in prostate surgery: Apixaban vs Rivaroxaban

What is it about?

This retrospective cohort study evaluates the perioperative risks associated with direct oral anticoagulants (DOACs) and warfarin in patients undergoing transurethral resection of the prostate (TURP). Among 629 patients analyzed, 18% were on anticoagulation therapy. Anticoagulated patients experienced higher risks of acute bleeding, prolonged haematuria, and perioperative stroke. Comparing DOACs, rivaroxaban users had a higher risk of acute bleeding compared to apixaban users. The study also highlighted an increase in TURP procedures among patients on anticoagulation therapy compared to earlier reports. Detailed analyses were conducted using patient demographics, preoperative parameters, and perioperative details. The findings stress the need for further research to guide clinicians in managing anticoagulation during TURP, balancing the risks of bleeding and thromboembolic events.

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Why is it important?

This research is important because it evaluates the perioperative risks associated with direct oral anticoagulants (DOACs) and warfarin in patients undergoing transurethral resection of prostate (TURP). As the prevalence of patients receiving anticoagulation therapy has increased significantly over the past decade, understanding the bleeding and thromboembolic risks in this population is crucial for optimizing perioperative management. The study provides valuable insights into the comparative risks of different anticoagulants, particularly DOACs, which have become increasingly common in clinical practice. This information can guide clinicians in making informed decisions about anticoagulation management in patients undergoing TURP, potentially improving patient outcomes and reducing complications. Key Takeaways: 1. Increased Risk: Patients receiving anticoagulation therapy have a significantly higher risk of acute bleeding, prolonged haematuria, and perioperative stroke compared to non-anticoagulated patients, even when therapy is withheld before surgery. 2. DOAC Comparison: Among DOACs, rivaroxaban appears to confer a higher risk of acute bleeding compared to apixaban, suggesting that the choice of DOAC may impact perioperative bleeding risk. 3. Prevalence Trend: The study notes a substantial increase in the prevalence of patients receiving anticoagulation therapy undergoing TURP, emphasizing the growing importance of understanding and managing these risks in urological practice.