Safety Study of Maintaining Oral Anticoagulant Therapy in Patients Undergoing Thulium Laser Enucleation of the Prostate for Benign Prostatic Hyperplasia
This retrospective study of 186 patients demonstrates that maintaining oral anticoagulant therapy during thulium laser enucleation of the prostate for benign prostatic hyperplasia is safe and feasible, as it does not increase perioperative bleeding risks while significantly reducing the incidence of thromboembolic events compared to withdrawing anticoagulants.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
For many older men, the prostate gland gradually enlarges, a condition known as benign prostatic hyperplasia. This growth squeezes the urethra, the tube that carries urine out of the body, leading to a frequent and urgent need to urinate, a weak stream, or the inability to empty the bladder completely. While medications can help, surgery is often the most effective solution for severe cases. At the same time, a growing number of older adults take daily blood-thinning medications to prevent dangerous clots caused by heart conditions like atrial fibrillation or previous strokes. This creates a difficult situation for surgeons: stopping the blood thinners before an operation reduces the risk of bleeding during the procedure, but it leaves the patient vulnerable to life-threatening clots. Keeping the medication on board prevents clots but raises the fear of excessive bleeding. Finding the right balance for patients who need both a prostate operation and blood thinners has long been a complex challenge in medical care.
Researchers at hospitals in Shanghai recently investigated this dilemma by looking at patients who underwent a specific type of prostate surgery called thulium laser enucleation. This technique uses a precise laser to peel away the enlarged prostate tissue from its surrounding capsule, much like removing the flesh from an orange while leaving the peel intact. The laser cuts with extreme accuracy and seals small blood vessels as it works, which helps control bleeding. To understand how to best manage blood thinners during this procedure, the medical team reviewed the records of 186 men who had this surgery between July 2023 and December 2024. They divided these men into three distinct groups to compare different approaches. The first group continued taking their usual blood-thinning pills right up to and through the surgery. The second group stopped their pills about a week before the operation and received temporary injections of a different blood thinner to bridge the gap, then restarted their pills after surgery. The third group served as a baseline; these men had never taken blood thinners and underwent the same surgery without any anticoagulant medication.
The study focused on whether keeping the blood thinners on board made the surgery riskier. The team measured how long the operations took, how much blood was lost, and how much the patients' hemoglobin levels dropped. They found no meaningful difference between the three groups. The surgeries took roughly the same amount of time, averaging around 66 to 68 minutes, and the amount of blood lost was nearly identical, hovering around 50 milliliters for everyone. Even the drop in hemoglobin, a measure of blood strength, was consistent across all groups. Most importantly, no patient in any group required a blood transfusion, and there were no severe bleeding events. This suggests that the precision of the laser technology effectively neutralized the potential bleeding risk that comes with continuing blood-thinning medication.
The researchers also tracked what happened after the surgery. They looked for common complications such as ongoing bleeding, blood in the urine for more than three days, urinary tract infections, or loss of bladder control. The rates of these issues were statistically similar across all three groups. Whether a man kept his pills, stopped them for injections, or took nothing at all, his chance of experiencing these common postoperative problems was the same. The time patients spent with a catheter in place and the number of days they stayed in the hospital were also nearly identical, indicating that continuing the medication did not slow down recovery.
However, a critical difference emerged when the team looked at blood clots. In the group that stopped their blood thinners for the surgery, five men developed serious clotting events, such as a blood clot in the leg or a stroke, representing about 8 percent of that group. In contrast, only one man in the group that continued their medication experienced a clot, a rate of roughly 1.6 percent. The group that never took blood thinners had no clotting events at all. This finding highlights a significant trade-off: while stopping the medication did not appear to increase bleeding risks thanks to the laser's effectiveness, it did significantly increase the danger of life-threatening clots. The group that kept taking their medication remained protected from clots at a level similar to those who never needed the drugs, without suffering any extra bleeding.
The study concluded that for men with an enlarged prostate who also rely on daily blood thinners, continuing the medication through a thulium laser prostate surgery is a safe and effective strategy. It does not increase the risk of bleeding during or after the operation, nor does it delay recovery or worsen the outcome of the surgery. Instead, it offers a crucial advantage by keeping the patient protected against dangerous blood clots, a risk that rises sharply when the medication is paused. The researchers suggest that this approach allows doctors to prioritize patient safety by avoiding the dangerous gap in protection that occurs when blood thinners are stopped, relying on the precision of modern laser technology to manage the surgical site.
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