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MINERVA UROLOGICA E NEFROLOGICA

A Journal on Nephrology and Urology


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Minerva Urologica e Nefrologica 2017 Dec 14

DOI: 10.23736/S0393-2249.17.03072-7

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Perioperative antithrombotic therapy in patients undergoing endoscopic urologic surgery: where do we stand with current literature?

Richard NASPRO 1 , Lori B. LERNER 2, Roberta ROSSINI 3, Michele MANICA 1, Henry H. WOO 4, Ross J. CALOPEDOS 4, Cecilia M. CRACCO 5, Cesare M. SCOFFONE 5, Thomas R. HERRMANN 6, Jean J. de la ROSETTE 7, Jean-Nicolas CORNU 8, Luigi F. DA POZZO 1

1 Department of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy; 2 Section of Urology, VA Boston Healthcare System, Boston, MA, USA; 3 Dipartimento Emergenza e Aree Critiche, Ospedale S. Croce e Carle, Cuneo, Italy; 4 Sydney Adventist Hospital Clinical School, University of Sydney, Wahroonga, Australia; 5 Department of Urology, Cottolengo Hospital of Turin, Turin, Italy; 6 Department of Urology and Urooncology, Hannover Medical School, Hannover, Germany; 7 Department of Urology, AMC University Hospital, Amsterdam, The Netherlands; 8 Service d’Urologie, CHU de Rouen, Rouen, France


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INTRODUCTION: The number of patients on chronic anticoagulant or antiplatelet therapy requiring endoscopic urological surgery is increasing worldwide. Therefore, there is a strong demand to standardize the peri-operative treatment of this cohort of patients, both from a surgical and cardiological point of view, balancing the risks of bleeding versus thrombosis, and the important possible clinical and medical legal repercussions therein.
EVIDENCE ACQUISITION: Although literature is scarce and the quality of evidence quite low, in line with other surgical specialties, guidelines and recommendations for the management of urological patients have begun to emerge.
EVIDENCE SYNTHESIS: The aim of this review is to analyze current available literature and evidence on the most common endoscopic procedures performed in this high risk group of patients, focusing on the peri-operative management. In particular, to analyze the most frequently performed endoscopic procedures for the treatment of benign prostate enlargement (transurethral resection of the prostate, Thulium, Holmium and greenlight laser prostatectomy), bladder cancer (transurethral resection of the bladder), upper urinary tract urothelial cancer, and nephrolithiasis.
CONCLUSIONS: Despite the lack of randomized studies, regardless of individual patient considerations, studies would support continuation of acetylsalicylic acid, which is recommended by cardiologists, in patients with intermediate/ high risk of coronary thrombosis. In contrast, multiple studies found that bridging with light weight molecular weight heparin can potentially lead to more bleeding than continuation of the anticoagulant(s) and antiplatelet therapy, and caution with bridging is advised. All urologists should familiarize themselves with emerging guidelines and recommendations, and always be prepared to discuss specific cases or scenarios in a dedicated multidisciplinary team.


KEY WORDS: Urological surgical procedures - Anticoagulants - Stents - Endoscopy - Aspirin

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Publication History

Article first published online: December 14, 2017
Manuscript accepted: December 1, 2017
Manuscript received: October 17, 2017

Cite this article as

Naspro R, Lerner LB, Rossini R, Manica M, Woo HH, Calopedos RJ, et al. Perioperative antithrombotic therapy in patients undergoing endoscopic urologic surgery: where do we stand with current literature? Minerva Urol Nefrol 2017 Dec 14. DOI: 10.23736/S0393-2249.17.03072-7

Corresponding author e-mail

nasprorichard@gmail.com