Thromboelastography in Long-Term Antiplatelet Therapy for Patients Diagnosed with Benign Prostate Hyperplasia Undergoing Holmium Laser Enucleation of the Prostate: A Retrospective Study

Overview

Journal Ther Clin Risk Manag

Publisher Dove Medical Press

Date 2024 Sep 16

PMID 39280636

Authors

Zhi-Bo Gu

Lei Qiu

Hua Zhu

Ming Lu

Jian-Gang Chen

Affiliations

Soon will be listed here.

Abstract

Objective: To compare low- vs high-power HoLEP effects on coagulation in patients on antiplatelet (AP) therapy via thromboelastography (TEG).

Methods: 210 patients was retrospectively analyzed and stratificated into three discrete groups, specifically: Group A (AP therapy, high-power HoLEP, n = 72); Group B (AP therapy, low-power HoLEP, n=73); Group C (no AP therapy, low-power HoLEP, n = 65). Baseline characteristics and coagulation profiles via TEG were compared. Univariate and multivariate analyses were conducted to identify independent risk factors associated with hematuria. Furthermore, parameters such as IPSS, Qmax, post-void residual volume V and PSA levels were recorded during 1year follow-up.

Results: No differences in terms of baseline characteristics across all groups. Significant differences were observed in the duration of enucleation, morcellation, bladder irrigation, post-operative catheterization, length of hospital stay and the extent of hemoglobin reduction (F = 54.06, 8.54, 6.68, 9.24, 17.06, 5.97, p < 0.05). No differences were noted in postoperative hematuria, urine retention, transfusion rates, and SUI (x = 1.082 ; x = 0.197,; x = 3.981;x = 0.816, p > 0.05). Univariate and multivariate analyses revealed that prostate volume emerged as an independent risk factor for hematuria (OR 1.080, 95% CI: 1.007-1.158, p = 0.031). Clinical outcomes including Qmax, IPSS, V, and PSA demonstrated significant enhancement during 1 year follow-up.

Conclusion: Compared to HP-HoLEP, LP-HoLEP effectively reduces surgical and subsequent processing times, decreases hospital stay duration, and diminishes hemoglobin decline, offering a viable option without discontinuing AP therapy.

References

Hartmann J, Curzen N . Modified Thromboelastography for Peri-interventional Assessment of Platelet Function in Cardiology Patients: A Narrative Review. Semin Thromb Hemost. 2022; 49(2):192-200. PMC: 9894686. DOI: 10.1055/s-0042-1757545. View

Teichman A, Cotton B, Byrne J, Dhillon N, Berndtson A, Price M . Approaches for optimizing venous thromboembolism prevention in injured patients: Findings from the consensus conference to implement optimal venous thromboembolism prophylaxis in trauma. J Trauma Acute Care Surg. 2023; 94(3):469-478. PMC: 9975027. DOI: 10.1097/TA.0000000000003854. View

Boeri L, Capogrosso P, Ventimiglia E, Fontana M, Sampogna G, Zanetti S . Clinical Comparison of Holmium Laser Enucleation of the Prostate and Bipolar Transurethral Enucleation of the Prostate in Patients Under Either Anticoagulation or Antiplatelet Therapy. Eur Urol Focus. 2019; 6(4):720-728. DOI: 10.1016/j.euf.2019.03.002. View

Mukhopadhyay T, Subramanian A . An overview of the potential sources of diagnostic errors in (classic) thromboelastography curve interpretation and preventive measures. Pract Lab Med. 2020; 22:e00193. PMC: 7723805. DOI: 10.1016/j.plabm.2020.e00193. View

Shah H, Etafy M, Katz J, Garcia Lopez E, Shah R . A randomized controlled trial comparing high and medium power settings for holmium laser enucleation of prostate. World J Urol. 2021; 39(8):3005-3011. DOI: 10.1007/s00345-020-03535-y. View

Lin C, Zhang J, Yang X, Cheng J, Sun L, Jiang M . Use of thromboelastography to monitor effects of the hemocoagulase on the blood coagulation in patients after thoracic surgery. Ann Palliat Med. 2020; 9(4):2090-2095. DOI: 10.21037/apm-20-1221. View

Agarwal D, Large T, Stoughton C, Heiman J, Nottingham C, Rivera M . Real-World Experience of Holmium Laser Enucleation of the Prostate with Patients on Anticoagulation Therapy. J Endourol. 2020; 35(7):1036-1041. DOI: 10.1089/end.2020.0886. View

Deuker M, Ruhrup J, Karakiewicz P, Welte M, Kluth L, Banek S . Holmium laser enucleation of the prostate: efficacy, safety and preoperative management in patients presenting with anticoagulation therapy. World J Urol. 2020; 39(4):1219-1226. PMC: 8124040. DOI: 10.1007/s00345-020-03272-2. View

Heiman J, Large T, Krambeck A . Best practice in the management of benign prostatic hyperplasia in the patients requiring anticoagulation. Ther Adv Urol. 2018; 10(12):431-436. PMC: 6295789. DOI: 10.1177/1756287218807591. View

10.

Netsch C, Herrmann T, Bozzini G, Berti L, Gross A, Becker B . Recent evidence for anatomic endoscopic enucleation of the prostate (AEEP) in patients with benign prostatic obstruction on antiplatelet or anticoagulant therapy. World J Urol. 2021; 39(9):3187-3196. DOI: 10.1007/s00345-021-03647-z. View

11.

Minagawa S, Okada S, Morikawa H . Safety and Effectiveness of Holmium Laser Enucleation of the Prostate Using a Low-power Laser. Urology. 2017; 110:51-55. DOI: 10.1016/j.urology.2017.08.034. View

12.

Becker B, Gross A, Netsch C . Safety and efficacy using a low-powered holmium laser for enucleation of the prostate (HoLEP): 12-month results from a prospective low-power HoLEP series. World J Urol. 2017; 36(3):441-447. DOI: 10.1007/s00345-017-2159-5. View

13.

Scoffone C, Cracco C . Prostate enucleation, better with low or high-power holmium laser? A systematic review. Arch Esp Urol. 2020; 73(8):745-752. View

14.

Becker B, Netsch C, Hansen J, Bohme A, Gross A, Zacharias M . Perioperative Safety in Patient Under Oral Anticoagulation During Holmium Laser Enucleation of the Prostate. J Endourol. 2018; 33(3):219-224. DOI: 10.1089/end.2018.0693. View

15.

Polymeris A, Macha K, Paciaroni M, Wilson D, Koga M, Cappellari M . Oral Anticoagulants in the Oldest Old with Recent Stroke and Atrial Fibrillation. Ann Neurol. 2021; 91(1):78-88. PMC: 9300111. DOI: 10.1002/ana.26267. View

16.

Habib E, ElSheemy M, Hossam A, Morsy S, Hussein H, Abdelaziz A . Holmium Laser Enucleation Versus Bipolar Plasmakinetic Resection for Management of Lower Urinary Tract Symptoms in Patients with Large-Volume Benign Prostatic Hyperplasia: Randomized-Controlled Trial. J Endourol. 2020; 35(2):171-179. DOI: 10.1089/end.2020.0636. View

17.

Launer B, McVary K, Ricke W, Lloyd G . The rising worldwide impact of benign prostatic hyperplasia. BJU Int. 2020; 127(6):722-728. PMC: 8170717. DOI: 10.1111/bju.15286. View

18.

Subramanian M, Kaplan L, Cannon J . Thromboelastography-Guided Resuscitation of the Trauma Patient. JAMA Surg. 2019; 154(12):1152-1153. DOI: 10.1001/jamasurg.2019.3136. View

19.

Gue Y, Memtsas V, Kanji R, Wellsted D, Busby A, Smith M . Impact of very low dose rivaroxaban in addition to dual antiplatelet therapy on endogenous fibrinolysis in acute coronary syndrome: The VaLiDate-R study. Thromb Res. 2024; 236:144-154. DOI: 10.1016/j.thromres.2024.02.030. View

20.

Karon B . Why is everyone so excited about thromboelastrography (TEG)?. Clin Chim Acta. 2014; 436:143-8. DOI: 10.1016/j.cca.2014.05.013. View