Evaluation of bleeding risk in patients on anticoagulation for mechanical cardiac valve operated for benign prostatic obstruction

To evaluate bleeding risk in patients on anticoagulation for mechanical cardiac valve operated for benign prostatic obstruction (BPO).

Fifty-eight patients operated between 1998 and 2014, in seven French departments of Urology were included. Forty-five patients were operated by conventional surgery (transurethral resection of the prostate 38, open simple prostatectomies 7), and 13 patients were operated by Greenlight™ photovaporization of the prostate (PVP). In order to assess bleeding risk, blood transfusion was considered as the primary outcome.

Fifteen (26%) patients received blood transfusion in the postoperative period. Mean duration of hospitalization was 8.5 days. Secondary surgery was required in 12 cases (21%), including endoscopic clot removal under general anaesthesia in 10 patients, and suprapubic haemostasis in 3 patients. One patient died 72hours after transurethral resection of the prostate because of a massive pulmonary embolism. Two independent predictors of blood transfusion were identified: conventional surgery use versus PVP, and high preoperative PSA. Blood transfusion rate was significantly lower in the group of patients operated by PVP compared to conventional surgery (0% versus 33%, P=0.010). In addition, the laser surgery was associated with shorter duration of hospitalization (3.4 days versus 9.9 days, P=0.014). However, it was not found any significant difference between patients operated by PVP compared to conventional surgery in terms of secondary bleeding (3/13 vs 8/45, P=0.7), or second surgery (2/13 vs 10/45, P=0.5).

Bleeding risk of BPO surgery in patients with mechanical cardiac valve is high. The PVP seems to decrease significantly the early haemorrhagic risk compared to classic surgical procedures for patients with mechanical cardiac valve.

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