Thrombotic risk factors associated with transurethral prostatectomy
C R Bell1, P J Murdock, K J Pasi
1Department of Urology, The Katherine Dormandy Haemophilia Centre, London, UK.
Objective:
To ascertain the potential thrombotic risk associated with transurethral prostatectomy (TURP).
Patients And Methods:
The changes in coagulation variables were assessed in a prospective study of 40 patients undergoing TURP.
Results:
There was a significant increase in thrombin-antithrombin complexes 6 h after TURP (anova, P=0.01) combined with a significant decrease in activated partial thromboplastin time (anova, P=0.006), suggesting a postoperative hypercoagulable state. The significant increase in d-dimer 24 h after TURP (anova, P=0.015) in the absence of any significant rise in tissue plasminogen activator antigen levels perioperatively (anova, P=0.737) suggests a physiological fibrinolytic response to the developing procoagulant state. The absence of any significant increase in plasminogen activator inhibitor-1 antigen perioperatively (anova, P=0.348) suggests the observed hypercoagulability is not due to a 'fibrinolytic shutdown' reported in other forms of surgery.
Conclusion:
TURP is associated with a hypercoagulable prothrombotic state; aspirin withdrawal perioperatively may be hazardous, and low-dose heparin prophylaxis for venous thrombosis should be considered.
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