The management of aspirin in transurethral prostatectomy: current practice in the UK
Mohamed Khalid Enver1, Ivan Hoh, Frank I Chinegwundoh
1Department of Urology, St Bartholomew's Hospital, London, UK. mkenver@hotmail.com
Insights
Urologists show varied practices regarding aspirin management before transurethral prostatectomy (TURP). Many stop aspirin, increasing cardiovascular risk, while others continue it, risking bleeding. Guidelines are needed for safe aspirin use in TURP patients.
Area of Science:
- Urology
- Cardiology
- Pharmacology
Background:
- Stopping aspirin before transurethral prostatectomy (TURP) may reduce bleeding but increase cardiovascular risks.
- Current management of aspirin in TURP patients lacks standardized guidelines.
- This study investigates the variability in peri-operative aspirin management for TURP patients.
Purpose of the Study:
- To determine the extent of variation in peri-operative aspirin management among UK urologists for TURP patients.
- To identify common practices and discrepancies in aspirin management protocols.
Main Methods:
- A questionnaire was distributed to 444 UK consultant urologists.
- 290 anonymous responses were received, with 287 suitable for analysis (65% response rate).
Main Results:
- 62% of urologists (178/287) instruct patients to stop aspirin before TURP, typically 10 days prior and resuming 7 days after.
- Of those stopping aspirin, 62% do so for all patients, and 40% would cancel surgery if aspirin was inadvertently continued.
- 38% of urologists (109/287) do not stop aspirin before TURP.
Conclusions:
- Significant variation exists in UK urologists' management of aspirin for TURP patients.
- Aspirin is often discontinued for extended periods, potentially endangering patients with high cardiovascular risk.
- There is a clear need for multidisciplinary guidelines to standardize aspirin management in TURP procedures and mitigate risks.
Introduction:
Stopping aspirin prior to transurethral prostatectomy (TURP) may minimise peri-operative blood loss, but it may also increase the risk of a significant cardiovascular event. There are no guidelines on the management of aspirin in TURP. This study sought to determine the variation in the peri-operative management of transurethral prostatectomy (TURP) patients that are taking aspirin.
Materials And Methods:
A questionnaire was sent to 444 consultant urologists in the UK from a list obtained from the British Association of Urologists. This resulted in 290 anonymous replies (65%), of which 287 were suitable for analysis.
Results:
Of these 287 urologists, 178 (62%) ask patients to stop aspirin prior to TURP. Aspirin is stopped 9.8 days (median, 10 days; range, 2-30 days) prior to surgery, and recommenced 8.8 days (median, 7 days; range, 1-42 days) after surgery. In those that stop aspirin, 62% will stop aspirin in all patients, regardless of the indication, and 40% will cancel a TURP if aspirin use has inadvertently continued. Of the 287 urologists, 109 (38%) do not stop aspirin.
Conclusions:
There is a wide variation in the management of aspirin in TURP patients in the UK. Aspirin is being stopped in patients at high risk of serious cardiovascular disease, often for longer than necessary. There is a need for multidisciplinary guidelines to reduce variation in practice.
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