Perioperative Management of Antithrombotic Agents in Urological Surgery

Abstract

Introduction:

There are no published urological guidelines for the management of antithrombotic agents during the perioperative period.

Aims:

To demonstrate variations in urological perioperative protocols for the antithrombotic agents aspirin, clopidogrel and warfarin.

Materials and methods:

Consultant urologists from the BAUS registry completed an online questionnaire on perioperative management of antithrombotic agents in urological surgery. Urologists were requested to indicate whether they routinely discontinued aspirin, clopidogrel or warfarin during the perioperative period for 11 different urological procedures. Respondents that discontinued an antithrombotic agent were requested to indicate the number of days the agent was discontinued preoperatively and recommenced postoperatively.

Results:

Of the 400 urologists surveyed, 210 (52.5%) responded. The percentage of respondents that continued each antithrombotic agent varied widely in each of the 11 procedures assessed (aspirin: range 48–82%; clopidogrel: 1–50%; warfarin: 2–40%). Respondents were most likely to continue an antithrombotic agent prior to diagnostic ureteroscopy (aspirin 82%, clopidogrel 50%, warfarin 40%) and least likely to continue prior to TURP (aspirin 45%, clopidogrel 2%, warfarin 2%).

Conclusions:

This is the first study addressing urological procedure-specific perioperative management policies for aspirin, clopidogrel and warfarin. Our findings suggest that perioperative management policies for antithrombotic agents are highly variable and appear arbitrary. Standardised guidelines need to be developed to reduce variations in current urological surgical practice.