Presentation Authors: Benjamin PRADERE*, Tours, France, Richard Naspro, Bergamo, Italy, Benoit Peyronnet, Rennes, France, Julien Guillotreau, Benoit Bordier, Toulouse, France, Kevin Zorn, Montréal, Canada, Vicent Misrai, Toulouse, France
Introduction: Photovaporisation of the prostate (PVP) by Greenlight laser has been developed especially to allow a better control of hemostasis during prostate vaporization. Nevertheless, perioperative management of anticoagulants (AC) is still debated, particularly the possibility of continuing AC during this period. The objective of our study was to assess the impact of continued AC on hemorrhagic complications.
Methods: All patients under anticoagulants (NOAC and AC) operated by PVP in two centers have been included prospectively. Patients characteristics were collected including the type of AC and if it was stopped, continued or bridged. Intraoperative and postoperative complications including hemorrhagic complications, were reported according to the Clavien-Dindo classification and divided in minor complications ( < 3) and major complications (â‰¥3). Two groups were analyzed and compared: AC continued and AC stopped. Chi2 test (or Fisher) were used for qualitative variables and t-test was used for quantitative variables.
Results: Among 185 patients from the cohort, 64 were under AC (AC n=57, NOAC n=7). Among them, 59% had their treatment stopped or bridged with heparin (LWMH) and 41% had their treatment continued during all the perioperative period. Preoperative patientâ€™s characteristics were similar in both groups. For complications, there was no difference between groups (37% vs. 46%; p=0.45) even for major complications (p=0.79). Hemorrhagic complications were also similar between groups: overall hemorrhagic complications 16% vs. 23% (p=0.46) or intravesical clotting (p=0.79). Functional outcomes at 6 months were also similar.
Conclusions: PVP for patients under AC is feasible. Continuing AC without a stop or a bridge during the perioperative period do not increase significantly the risk of postoperative complications and especially hemorrhagic complications. These results could be considered to go to a simplified management of patients under AC, suggesting that AC could be continued for these fragile patients.