Table 2.
Antithrombotic agents and HoLEP
| Study | N | Control group | Study characteristics | Outcomes |
|---|---|---|---|---|
| El Tayeb et al20 | 116 | 1,558 | • 30 continued antithrombotics (1 dipyridamole/aspirin, 9 aspirin 325 mg, 10 clopidogrel, 15 warfarin, 3 dabigatran, 2 enoxaparin) • 86 held antithrombotics perioperatively (1 dipyridamole/aspirin, 39 aspirin 325 mg, 36 clopidogrel, 35 warfarin, 2 dabigatran) |
Men on antithrombotic therapy had: • Shorter enucleation times (51 vs 65 min, P<0.001) • Faster morcellation rates (5 vs 4.5 g/min, P=0.022) • Longer LOS (27.8 vs 24 h, P<0.001) • Longer CBI (15 vs 13.5 h, P<0.001) • Similar transfusion (3.5% vs 1.6%, P=0.13) Men on continuous vs intermittent AC/AP had: • Lower specimen weight (55.5 vs 74.5 g, P=0.028) • Similar transfusion rate (6.7 vs 2.3%, P=0.27) (thromboembolic complications not discussed) |
| Bishop et al21 | 52 | 73 | • Antithrombotics taken through HoLEP: 3 dipyridamole/aspirin, 16 clopidogrel, 22 warfarin • Men on antithrombotics were significantly older (75.1 vs 71.7 y, P=0.02) and had a higher ASA score (3 vs 2, P<0.0001) |
Antithrombotic arm had: • A longer LOS (2 vs 1 d, P=0.014) • Higher transfusion rate (7.7 vs 0%, P=0.028) No thromboembolic complications in either group |
| Tyson andLerner22 | 39 | 37 | • 13 warfarin (mean INR 1.5), 25 aspirin, 1 clopidogrel continued through surgery | • Significant intraoperative hematuria obscuring vision resulting in staged procedure occurred in 5 controls and 2 on antithrombotics (P=0.34) • No patient required a blood transfusion |
| Elzayat et al23 | 83 | None | • 14 antithrombotics continued through HoLEP • 34 on LMWH substitution through HoLEP • 33 held antithrombotics prior to HoLEP • 2 men with hemophilia |
Blood transfusion rate: • 2 (14.2%) on continued antithrombotic therapy • 5 (14.7%) on LMWH through HoLEP • One patient on clopidogrel required Plavix® (clopidogrel bisulfate) intraop and staged morcellation |
Abbreviations: N, number; LOS, length of stay; CBI, continuous bladder irrigation; LMWH, low-molecular-weight heparin; HoLEP, holmium laser enucleation of the prostate; y, years; d, days; min, minutes; h, hours; AC/AP, anticoagulation and antiplatelet medication; cont, continous; intraop, intraoperatively.