Oral anticoagulation therapy and laser surgery for benign prostatic hyperplasia: stop, replace, or continue?

Area of Science:

• Urology
• Cardiology
• Anesthesiology

Background:

• Benign prostatic obstruction (BPO) is a common condition requiring treatment.
• Antithrombotic therapy is frequently used in patients with cardiovascular conditions.
• Laser surgery is a common treatment for BPO.

Purpose of the Study:

• To review the literature on laser surgery for BPO in patients taking antithrombotic medications.
• To assess the safety and efficacy of laser procedures for BPO under antithrombotic therapy.

Main Methods:

• Literature review of studies assessing laser surgery for BPO in patients on antithrombotics.
• Analysis of perioperative management strategies for antithrombotic agents.

Main Results:

• Laser surgery appears feasible for BPO patients on antithrombotics, with potential for reduced bleeding risk.
• No consensus exists on optimal perioperative antithrombotic management.
• Continuation of low-dose aspirin may be safe, but data on clopidogrel, coumarin derivatives, and novel oral anticoagulants are limited and heterogeneous.

Conclusions:

• Decision-making regarding antithrombotic management requires a multidisciplinary approach involving urologists, cardiologists, and anesthesiologists, balancing thrombotic and hemorrhagic risks.
• High-quality evidence is lacking for definitive perioperative antithrombotic management guidelines during laser BPO procedures.