Bleeding Events Associated With Continuing Antithrombotic Therapy During Transrectal Ultrasound-Guided Prostate
Kenichi Hata1,2,3, Yuma Goto2,3, Masaki Hashimoto2,3
1Department of Urology, Shonan Keiiku Hospital, Fujisawa, Kanagawa, Japan.
Insights
Continuing antithrombotic therapy during prostate biopsies is safe, showing no increased bleeding risk. However, caution is advised for direct-acting oral anticoagulants in patients with diabetes.
Area of Science:
- Urology
- Cardiology
- Oncology
Background:
- Prostate biopsies are common procedures.
- Antithrombotic therapy is frequently used in patients undergoing prostate biopsies.
- The safety of continuing antithrombotic therapy during these biopsies is a critical consideration.
Purpose of the Study:
- To assess the association between continuing antithrombotic therapy and bleeding events.
- To evaluate the frequency and severity of bleeding during transrectal ultrasound-guided prostate biopsies.
- To compare bleeding rates in patients who continued versus discontinued antithrombotic therapy.
Main Methods:
- Retrospective cohort study of 1248 patients undergoing prostate biopsy.
- Patients were grouped based on antithrombotic therapy continuation (antithrombotic(+) vs. antithrombotic(-)).
- Propensity score matching (1:1) was used to control for confounding factors.
Main Results:
- Matched analysis (162 patients/group) showed comparable rates of mild/severe hematuria and rectal bleeding.
- No significant difference in hematospermia rates was observed.
- Diabetes mellitus and biopsy core number were independent predictors of severe bleeding.
Conclusions:
- Transrectal ultrasound-guided prostate biopsy is safe without antithrombotic discontinuation.
- No significant increase in bleeding events was observed when antithrombotic therapy was continued.
- Caution is advised for direct-acting oral anticoagulants in patients with bleeding risk factors like diabetes.
Objectives:
To evaluate the association between antithrombotic continuation and the frequency and severity of bleeding events during transrectal ultrasound-guided prostate biopsies.
Methods:
This retrospective cohort study involved 1248 patients who underwent transrectal ultrasound-guided prostate biopsy between April 2018 and December 2024. Patients were grouped into antithrombotic(+) (continued therapy) or antithrombotic(-) (no therapy). The groups were matched 1:1 using propensity scores based on patient demographics.
Results:
Propensity score matching yielded 162 patients per group. Mild and severe hematuria rates were comparable between the antithrombotic(+) and antithrombotic(-) groups (80.9% and 1.9% vs. 72.8% and 2.5%), with overall rectal bleeding occurring in 29.6% and 29.0%, respectively. Hematospermia rates did not differ significantly. In the unmatched direct-acting oral anticoagulant cohort, severe rectal bleeding occurred in three patients (5.7%). Multivariate analysis identified diabetes mellitus (odds ratio, 3.47, 95% confidence interval, 1.10-10.96; p = 0.034) and biopsy core number (odds ratio, 0.39, 95% confidence interval, 0.21-0.74; p = 0.004) as independent predictors of severe bleeding events.
Conclusions:
Transrectal ultrasound-guided prostate biopsy was generally safe without antithrombotic discontinuation, with no significant increase in bleeding events. Caution is warranted when continuing direct-acting oral anticoagulants, particularly in patients with risk factors for bleeding, such as diabetes mellitus.
