Morbidity and mortality outcomes associated with early anticoagulation recommencement following TURP.

Abstract

Introduction and Objectives: TURP is the gold standard treatment for symptoms of bladder outflow obstruction in men with BPH, however it does carry risks of perioperative bleeding. Balancing the risk of post-operative bleeding in patients requiring anti-thrombotic therapy with the need to prevent potentially life-threatening thromboembolic events makes this a particularly complex decision in surgical planning. This study aimed to retrospectively evaluate the impact of anticoagulation recommencement timing in patients undergoing TURP on post-operative haemorrhage and cardiovascular outcomes. Method(s): A retrospective review of patients who underwent TURP (N = 106) at a tertiary health service between 1/1/2025 and 10/8/2025 was conducted by extracting data from electronic medical records. The following variables were collected: age, TURP type (monopolar vs bipolar), preoperative anti-thrombotic regimen (anticoagulant, antiplatelet), and indication for therapy (e.g., Atrial Fibrillation, Ischemic Heart Disease, prior stroke). Details regarding perioperative management were collated, including preoperative discussion with cardiology/ haematology, the time to recommencement of antithrombotic therapy postoperatively, and the occurrence of postoperative complications. The primary outcomes measured were major adverse cardiovascular/cerebrovascular events, readmission for hematuria, return to theatre for clot evacuation (RTT), and blood transfusion (PRBC) within 3 months post-operatively. Patients were grouped into: Nil anti-thrombotics = group A (N = 63) Aspirin only therapy = group B (N = 25) Anticoagulants recommenced <14 days post-operatively = group C (N = 11) Anticoagulants recommenced >=14 days post-operatively = group D (N = 7) Results: 6.6% of the TURP patients required urological readmission due to haematuria. Representation with haematuria was 5.9 times higher in those on anticoagulation (95% CI, 1.32-26.4, P = 0.02) Rate of readmission was highest in those in group D (28.6%) compared with group C (18.2%), group B (12%), and group A (0%). 42.9% of readmissions required RTT. RTT rate was highest in group C (18.2%), vs group B (4.0%) vs group D (0%). PRBC rate was 1.9% (100% of those being from group C). No deaths or CVA/CVS episodes were observed. Conclusion(s): The recommencement of anticoagulation prior to the standard protocol of 14 days appeared to have higher incidences of postoperative haemorrhage-associated morbidity without any observable protection from the incidence of CVA/CVS. The occurrence of postoperative haemorrhage in patients with high CVA/CVS risk who recommence anticoagulation early may paradoxically lead to a longer total period without therapy. However, further research with larger sample sizes is required to further evaluate this issue.