Background and Importance The management of anticoagulation in patients undergoing surgical procedures like transurethral resection (TUR) is challenging. A balance between reducing thromboembolism risk and preventing excessive bleeding must be reached. This risk is aggravated in patients treated with anticoagulants.
Aim and Objectives The aim of the study was to assess the adequacy bridging anticoagulation after TUR in patients treated with direct-acting oral anticoagulants (DOACs) or Vitamin K antagonists (VKAs) to prevent stroke in atrial fibrillation (AF).
Material and Methods Retrospective observational study carried out in an area reference hospital serving a population of 200,000 inhabitants, from January 2021 to June 2022. Patients who underwent TUR with diagnostic of AF were included. Data were obtained from Minimum Basic Data Set (CMBD). We reviewed whether patients were anticoagulated, the type of anticoagulant drug prescribed (VKA, DOAC) and the prescribed drug (acenocoumarol, warfarin, dabigatran, rivaroxaban, apixaban, edoxaban). We verified whether the reintroduction of anticoagulant treatment after TUR was appropriate to hospital protocol and the rate of subsequent readmissions due to bleeding.
Because of the moderate bleeding risk of TUR, the protocol for reintroducing anticoagulant medication after TUR in the case of patients treated with VKAs consists of administering bemiparin or enoxaparin at anticoagulant doses 24 hours after TUR together with the usual dose of acenocoumarol or warfarin. In the case of patients treated with DOAC, the protocol consists of reintroducing their medication at the usual dose 24 hours after TUR.
Results The mean age of the 37 included patients was 81 ± 6 years. 94.6% were male. 89.19% of the patients were anticoagulated (60% AVK, 40% DOAC).
The protocol for reintroducing anticoagulant treatment was not followed in 100% of anticoagulated patients. The drug prescribed in these cases after TUR was bemiparin at a prophylactic dose of 3500 IU every 24 hours.
59.5% of patients were attended at Emergency Department (ED) after TUR with haematuria diagnostic.
Conclusion and Relevance Although anticoagulation was not reintroduced as the protocol established, more than 50% of patients were readmitted in the ED for haematuria. Therefore, our study confirms that appropriate interruption of anticoagulation in the perioperative period is a delicate balancing act between complications of bleeding and thrombosis.
Conflict of Interest No conflict of interest
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