Photo Credit: Dr_Microbe

The following is a summary of “To Hold or Continue Blood Thinners? A Retrospective Analysis on Outcomes of Holmium Laser Enucleation of the Prostate (HoLEP) in Patients who Either Held or Continued Antiplatelet/Anticoagulation Therapy,” published in the August 2024 issue of Urology by Xu et al.

This study aimed to evaluate and compare the clinical outcomes of patients undergoing holmium laser enucleation of the prostate (HoLEP) who either held or continued antiplatelet/anticoagulation (APAC) therapy. Researchers conducted a retrospective review of patients on APAC who underwent HoLEP between January 2021 and August 2023 by a single surgeon at a high-volume medical center. APAC medications were categorized into specific drugs: clopidogrel, apixaban, warfarin, and rivaroxaban. The study group analyzed preoperative, intraoperative, and postoperative characteristics and outcomes, employing SPSS for statistical analysis with significance set at p<0.05.

Among the 139 patients on APAC, 82 held and 57 continued therapy. The cohort included 38 patients on clopidogrel (21 held), 20 on warfarin (11 held), 57 on apixaban (34 held), and 24 on rivaroxaban (16 held). Overall, there were no statistically significant differences in outcomes between those who held versus those who continued APAC. However, a sub-analysis, controlling for age and prostate size, revealed that patients who held clopidogrel had a shorter length of stay (11.3 hours vs. 27.3 hours, p=0.016), a higher likelihood of same-day catheter removal (90.5% vs. 47.1%, p=0.002), and increased rates of same-day discharge (90.5% vs. 35.3%, p=0.002). Furthermore, patients who held warfarin experienced shorter procedure times (61.3 minutes vs. 92.2 minutes, p=0.025) and morcellation times (7.36 minutes vs. 18 minutes, p=0.048).

In conclusion, HoLEP is a safe and effective procedure for patients regardless of whether APAC therapy is held or continued during surgery. Notably, holding clopidogrel may reduce hospital length of stay and improve same-day catheter removal and discharge rates. Additionally, patients on warfarin who held therapy experienced shorter morcellation and overall procedure times. These findings suggest potential benefits in specific scenarios when considering the management of APAC in the perioperative setting.

Source: sciencedirect.com/science/article/abs/pii/S0090429524007416