PMID- 33280490
OWN - NLM
STAT- MEDLINE
DCOM- 20210805
LR  - 20210805
IS  - 1557-900X (Electronic)
IS  - 0892-7790 (Linking)
VI  - 35
IP  - 7
DP  - 2021 Jul
TI  - Real-World Experience of Holmium Laser Enucleation of the Prostate with Patients 
      on Anticoagulation Therapy.
PG  - 1036-1041
LID - 10.1089/end.2020.0886 [doi]
AB  - Background: Holmium laser enucleation of the prostate (HoLEP) is a highly 
      effective procedure for benign prostatic hyperplasia that is size independent and 
      has been recommended for patients necessitating antiplatelet (AP) and 
      anticoagulant (AC) medications. Although HoLEP is feasible in AP/AC patients, 
      there is a lack of published results on real-world outcomes of patients on AP/AC 
      therapy undergoing HoLEP. Patients and Methods: We performed a retrospective 
      review of our institutional HoLEP database of demographics, perioperative and 
      postoperative data, and outcomes of patients on AP and AC therapy compared with 
      none. We also further stratified patients on warfarin compared with direct oral 
      anticoagulants (DOACs). Results: Of 472 patients who underwent HoLEP at our 
      institution from July 2018 to December 2019 with data on AP/AC drugs, 30 (6.3%) 
      were on AP and 65 (17.2%) were on AC. One patient continued AP (3.3%), six 
      patients (9.2%) were bridged on AC, and one patient (1.5%) continued AC through 
      the time of HoLEP at the discretion of the prescribing provider. Preoperatively, 
      only age was significantly different among the three groups (p < 0.001). There 
      were no intraoperative differences. Postoperatively, there was a higher 90-day 
      complication rate in AP and AC groups (p = 0.035), but not an increase in 
      emergency department (ED) visits (p = 0.557) or Clavien >/=3 complications 
      (p = 0.16). In comparison of patients on warfarin with DOAC, there was a lower 
      rate of successful voiding trial (p = 0.009), higher 90-day complications 
      (p = 0.003), and more ED visits (p = 0.003) in the warfarin group. Conclusions: 
      HoLEP is safe and effective for patients who require AP or AC therapy. There is 
      no increase in serious complications or worsened postoperative voiding 
      parameters. Of patients on AC, those on DOAC have better outcomes compared with 
      warfarin.
FAU - Agarwal, Deepak K
AU  - Agarwal DK
AD  - Department of Urology, Indiana University School of Medicine, Indianapolis, 
      Indiana, USA.
FAU - Large, Tim
AU  - Large T
AD  - Department of Urology, Indiana University School of Medicine, Indianapolis, 
      Indiana, USA.
FAU - Stoughton, Christa L
AU  - Stoughton CL
AD  - Department of Urology, Indiana University School of Medicine, Indianapolis, 
      Indiana, USA.
FAU - Heiman, Joshua M
AU  - Heiman JM
AD  - Department of Urology, Indiana University School of Medicine, Indianapolis, 
      Indiana, USA.
FAU - Nottingham, Charles U
AU  - Nottingham CU
AD  - Department of Urology, Indiana University School of Medicine, Indianapolis, 
      Indiana, USA.
FAU - Rivera, Marcelino E
AU  - Rivera ME
AD  - Department of Urology, Indiana University School of Medicine, Indianapolis, 
      Indiana, USA.
FAU - Krambeck, Amy E
AU  - Krambeck AE
AD  - Department of Urology, Indiana University School of Medicine, Indianapolis, 
      Indiana, USA.
LA  - eng
PT  - Journal Article
DEP - 20210106
PL  - United States
TA  - J Endourol
JT  - Journal of endourology
JID - 8807503
RN  - 0 (Anticoagulants)
RN  - W1XX32SQN1 (Holmium)
SB  - IM
MH  - Anticoagulants/therapeutic use
MH  - Holmium
MH  - Humans
MH  - *Laser Therapy
MH  - *Lasers, Solid-State/therapeutic use
MH  - Male
MH  - Prostate/surgery
MH  - *Prostatic Hyperplasia/drug therapy/surgery
MH  - Retrospective Studies
MH  - *Transurethral Resection of Prostate
MH  - Treatment Outcome
OTO - NOTNLM
OT  - anticoagulation
OT  - benign prostatic hyperplasia
OT  - holmium laser
OT  - outcomes
OT  - prostate enucleation
EDAT- 2020/12/08 06:00
MHDA- 2021/08/06 06:00
CRDT- 2020/12/07 05:22
PHST- 2020/12/08 06:00 [pubmed]
PHST- 2021/08/06 06:00 [medline]
PHST- 2020/12/07 05:22 [entrez]
AID - 10.1089/end.2020.0886 [doi]
PST - ppublish
SO  - J Endourol. 2021 Jul;35(7):1036-1041. doi: 10.1089/end.2020.0886. Epub 2021 Jan 
      6.