To stop or not to stop. Endoscopic enucleation of the prostate in patients on blood thinners: outcomes, a real-life prospective multicenter study of 932 cases.
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Castellani Daniele, Yuen Steffi Kar-Kei, Giulioni Carlo, Fong Khi Yung, Doizi Steeve, Moretto Stefano, Zawadzki Marek, Tanidir Yiloren, Gökce Mehmet Ilker, Mahajan Abhay, Sytnik Dmitriy, Alkandari Abdulrahman, Becker Benedikt, Aydin Cemil, Akdogan Nebil, Bulut Ender Cem, More Sumit, De Coninck Vincent, Xu Abai, Gadzhiev Nariman, Malkhasyan Vigen, Tan Karl, Lim Yong Wei, Laymon Mahmoud Nabil Ismail, Mazzon Giorgio, Sarvajit Biligere Priyadarshi, Chiruvella Mallikarjuna, Enikeev Dmitry, Somani Bhaskar, AbdelAziz Omar, Herrmann Thomas, Gauhar Vineet
Аннотация
METHODS: BPH patients on blood thinners planned for EEP were prospectively enrolled from 30 centers (December 2024-June 2025). Patients were divided into Group 1 (continued blood thinners, n = 329) and Group 2 (discontinued blood thinners, n = 603). Outcomes included bleeding complications, hospital stay, and functional results. Multivariable logistic regression identified predictors of postoperative bleeding (blood transfusion, need for restarting of continuous bladder washout, clot retention, surgical control of post-operative bleeding).
RESULTS: The overall population had a median age of 70.0 years and prostate volume of 81.0 ml. Group 1 patients had higher comorbidity rates. Group 1 demonstrated significantly longer median operative times (87.0 vs. 70.0 min, p < 0.001) and increased bleeding-related complications, including continuous bladder washout restart (14.3% vs. 2.5%, p < 0.001), blood transfusion requirements (1.5% vs. 0.5%, p < 0.001), and hospital readmissions (10.0% vs. 4.1%, p < 0.001). Rates of surgical hemostasis intervention were similar (1.8% in Group 1 vs. 2.0% in Group 2, p = 0.92). No major thrombotic events occurred. Independent predictors of bleeding included longer operative time (OR 1.01, p < 0.001) and combination antiplatelet/anticoagulant therapy (OR 2.47, p = 0.04), while tranexamic acid was associated with lower odds (OR 0.18, p < 0.001).
CONCLUSION: EEP can be safely performed in patients on blood thinners with acceptable morbidity, though bleeding complications are higher. Combination therapy carries the highest risk, while tranexamic acid reduces bleeding complications.