Objective: To systematically evaluate the risk of antiplatelet drugs (APs) on bleeding complications in urological surgery. Methods: Studies were sought and included in this review if they were clinical controlled trials and involved transurethral resection of the prostate (TURP) and prostate puncture biopsy (PPB), which compared preoperative AP withdrawal (control group) with continuing APs (experimental group) and revealed bleeding complications as outcomes. A literature search was conducted of the electronic databases PubMed, Ovid, ScienceDirect and Embase for studies published between 1990 and 2012. Two reviewers independently screened the studies for eligibility, evaluated the quality and extracted the data from the eligible studies, with confirmation by cross-checking. There was evidence of publication bias based on Egger’s test and funnel plot. Data were processed using Cochrane Review Manager 5.0 software. Results: Nine studies involving 3,145 cases met the inclusion criteria and were included in the meta-analysis. The baselines of patients’ characteristics were comparable in all studies. The meta-analysis results showed that no differences were found in risk of bleeding after (1) TURP (OR 1.26, 95% CI 0.80–2.00, p = 0.32) or (2) PPB (OR 0.89, 95% CI 0.45–1.76, p = 0.73). Conclusion: Preoperative APs do not raise the risk of surgical bleeding complications in prostatectomy and PPB. Because of few studies and small samples, more high-quality trials with larger samples and longer follow-ups are proposed.

Keywords:
Meta-analysis, Antiplatelet drugs, Bleeding, Transurethral resection of the prostate, Prostate puncture biopsy
1.
Burger W, Chemnitius JM, Kneissl GD, Rucker G: Low-dose aspirin for secondary cardiovascular prevention: cardiovascular risks after its perioperation withdrawal versus bleeding risks with its continuation: review and meta-analysis. J Intern Med 2005;257:399–414.
2.
Kretschmer V: Perioperative risk of hemorrhage in urologic operations caused by administration of aspirin. Urologe A 1998;37:675.
3.
Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DM, Gavaghan DJ, McQuay HJ: Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996;17:1–12.
4.
Liu J: Systematic review of nonrandomized controlled trials. Chin J Evid Based Med 2001;1:239–243.
5.
Ala-Opas MY, Gronlund SS: Blood loss in long-term aspirin users undergoing transurethral prostatectomy. Scand J Urol Nephrol 1996;30:203–206.
6.
Wierød FS, Frandsen NJ, Jacobsen JD, Hartvigsen A, Olsen PR: Risk of haemorrhage from transurethral prostatectomy in acetylsalicylic acid and NSAID-treated patients. Scand J Urol Nephrol 1998;32:120–122.
7.
Giannarin G, Mogorovich A, Valent F, Morelli G, De Maria M, Manassero F, Barbione F, Selli C: Continuing or discontinuing low-dose aspirin before transrectal prostate puncture biopsy: results of a prospective randomized trial. Urology 2007;70:501–505.
8.
Herget EJ, Saliken JC, Donnelly BJ, Gray RR, Wiseman D, Brunet G: Transrectal ultrasound-guided biopsy of the prostate: relation between aspirin use and bleeding complications. Can Assoc Radiol J 1999;50:173–176.
9.
Kariotis I, Philippou P, Volanis D, Serafetinides E, Delakas D: Safety of ultrasound-guided transrectal extended prostate puncture biopsy in patents receiving low-dose aspirin. Int Braz J Urol 2010;36:308–316.
10.
Maan Z, Cutting CW, Patel U, Kerry S, Pietrzak P, Perry MJA, Kirby RS: Morbidity of transrectal ultrasonography-guided prostate biopsies in patients after the continued use of low-dose aspirin. BJU Int 2003;91: 798–800.
11.
Nielsen JD, Holm-Nielsen A, Jespersen J, Vinther CC, Settgast IW, Gram J: The effect of low-dose acetylsalicylic acid on bleeding after transurethral prostatectomy – a prospective, randomized, double-blind, placebo-controlled study. Scand J Urol Nephrol 2000;34:194–198.
12.
Rosenthal R: The ‘file drawer problem’ and tolerance for null results. Psychol Bull 1979;86:638–641.
13.
Thurston AV, Briant SL: Aspirin and post-prostatectomy haemorrhage. Br J Urol 1993;71:574–576.
14.
Watson CJ, Deane AM, Doyle PT, Bullock KN: Identifiable factors in post-prostatectomy haemorrhage: the role of aspirin. Br J Urol 1990;66:85–87.
15.
Freiberg A, Cantor R, Freiberg R: The use of aspirin to prevent heterotopic ossification after total hip arthroplasty. Clin Orthop 1991;267:93–96.
16.
Schmidt S, Andersen P, Pedersen NW, Kristensen SS, Pedersen P, Nielsen JB: The use of indomethacin to prevent the formation of heterotopic bone after total hip replacement. J Bone Joint Surg Am 1988;70:834–838.
17.
Stage J, Jensen J, Bonding P: Post-tonsillectomy haemorrhage and analgesics. A comparative study of acetylsalicylic acid and paracetamol. Clin Otolaryngol 1988;13:201–204.
18.
Taggart D, Siddiqui A, Wheatley D: Low-dose preoperative aspirin therapy, postoperative blood loss and transfusion requirements. Thorac Surg 1990;50:425–428.
19.
Kearon C, Hirsh J: Management of anticoagulation before and after elective surgery. N Engl J Med 1997;336:1506–1511.
© 2012 S. Karger AG, Basel
2012
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