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Perioperative adverse events in patients on continued anticoagulation undergoing photoselective vaporisation of the prostate with the 180‐W Greenlight lithium triborate laser
Author(s) -
Knapp Georgia L.,
Chalasani Venu,
Woo Henry H.
Publication year - 2017
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.13822
Subject(s) - medicine , perioperative , incidence (geometry) , adverse effect , anesthesia , warfarin , anticoagulant , clopidogrel , surgery , atrial fibrillation , myocardial infarction , physics , optics
Objectives To compare perioperative factors and adverse events ( AE s) in men undergoing photoselective vaporisation of the prostate ( PVP ) with or without continued anticoagulation therapy. Patients and Methods Retrospective review of a PVP database of men treated with the 180‐W lithium triborate ( LBO ) laser from 2010 to 2016. Of 373 men, 59 underwent PVP with continued anticoagulant therapy, which was defined as treatment with heparin, warfarin, clopidogrel, dipyridamol or new oral anticoagulant drugs. Perioperative factors and AE s occurring within 90 days of surgery were analysed. Results There was no statistically significant difference in the overall incidence of perioperative AE s between those receiving and not receiving anticoagulation therapy (30.5% vs 19.9%, P = 0.07). However, there was a statistically significant difference in the incidence of high‐grade Clavien–Dindo events in men who continued anticoagulation during PVP ( P = 0.01). No men required blood transfusion. There was no difference in operative times and energy utilisation between the groups. In all, 53 of the 59 men in the anticoagulation group had a high‐grade American Society of Anesthesiologists score, compared to 27 of the 272 men in the control group. The anticoagulation group were also significantly older. The anticoagulation group had a significantly longer length of hospital stay and duration of catheterisation compared to the controls. Conclusions While continued anticoagulation therapy is not associated with an overall increase in perioperative AE s, it is associated with an increased rate of high‐grade Clavien–Dindo events. The findings of this study suggest that there should be caution in extrapolating results about the safety profile of earlier generation lasers to the current 180‐W LBO laser for patients on anticoagulation.