EAU 2018: Morbidity Evaluation of Antiplatelet and Anticoagulant Treatments According to Their Perioperative Management During Photovaporisation of the Prostate by Greenlight Laser

Copenhagen, Denmark (UroToday.com)  Dr. B. Pradere, clinical urologist from the CHU Tours in Tours, France, shared his findings on the feasibility of photovaporizaiton of the prostate (PVP) by Greenlight laser  for patients who are unable to undergo surgery without taking antiplatelet (AP) or anticoagulant (AC) medications. Dr. Pradere and his team attempted to evaluate the morbidity of the PVP procedure in these patients according to their preoperative management. The researchers created a multi-institutional database that included all the patients undergoing a PVP procedure while simultaneously taking an AP or AC medication between 2014 and 2016. The preoperative parameters that differentiated the patient cohorts were based on whether or not the medication was continued or stopped preoperatively. Asprin was given to every patient regardless of preoperative management, making asprin the control factor. Perioperative morbidity was classified by the Clavien-Dindo classification and cohorts were divided based on minor complications (Clavien < 3), major complications (≥ 3), hemorrhagic complications, and conversion to transurethral resection of prostate (TURP). 

At the completion of the study, 185 patients had been identified and enrolled in the study; 121 of these patients were in the AP group while 64 were in the AC group. The AP medication given was either aspirin, clopidogrel, or derivate while the AC medication given was coumadin, warfarin, or NOAC. In a head-to-head comparison between AC and AP, there was no significant difference between the aforementioned morbidity data points. This trend was also present in a comparison of aspirin vs. AC medication. However, when comparing whether aspirin (n=97) vs. clopidogrel and derivate (n=38), major and hemorrhagic complication rates were significantly higher in the clopidogrel and derivate cohort. 

In closing, Dr. Pradere reiterated how clopidogrel did have an effect on major and hemorrhagic complications during PVP while anticoagulants had no increased morbidity. In order to further confirm these results, a prospective, randomized trial is necessary. 

Presented by: B. Pradere, MD, CHU Tours, Dept. of Urology, Tours, France

Co Authors:  Peyronnet B., Guillotreau J., Bordier B., Naspro R., Misrai V. 
Author Information: CHU Tours, Dept. of Urology, Tours, France 

Written by: Zachary Valley MD, Department of Urology, University of California-Irvine at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark
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