Hemorrhagic Risk of Transrectal Ultrasound-Guided Prostate Biopsy Under Continued Antithrombotic Therapy

To evaluate the safety of transrectal ultrasound (TRUS)-guided prostate biopsy performed without interruption of antithrombotic therapy.

In this single-center retrospective study, we analyzed 2394 consecutive patients who underwent TRUS-guided prostate biopsy under sacral (caudal) anesthesia between July 2011 and March 2023. Patients were classified according to antithrombotic status at biopsy: no antithrombotic therapy, antiplatelet therapy, or anticoagulant therapy. Hemorrhagic complications were graded using the Clavien-Dindo classification. The primary endpoint was any Clavien-Dindo grade II or higher hemorrhagic complication; grade II and grade III events were also examined. Multivariable logistic regression analyses were performed with antithrombotic status as the main explanatory variable and age and platelet count as covariates.

Overall, 29 patients (1.2%) developed Clavien-Dindo grade II or higher hemorrhagic complications: 1.1% in the no antithrombotic group, 1.5% in the antiplatelet group, and 2.5% in the anticoagulant group. Neither antiplatelet nor anticoagulant therapy was associated with a significant increase in hemorrhagic complications compared with no antithrombotic therapy. No thromboembolic events were observed.

TRUS-guided prostate biopsy under sacral anesthesia appeared feasible without discontinuation of antithrombotic therapy and was not associated with a clear excess of clinically significant hemorrhagic complications. In selected patients, particularly those at high thromboembolic risk, continuing antithrombotic therapy may be a reasonable option, although a modest increase in bleeding risk cannot be definitively excluded.