Presented by: T. Max Shelton MD
Indiana University School of Medicine

Introduction

Anticoagulant usage raises questions about these medications’ impact on hemostasis during Holmium Laser Enucleation of the Prostate (HoLEP). We performed a retrospective review of HoLEP patients on anticoagulant (AC) or antiplatelet (AP) medications to examine their impact on operating efficiency during HoLEP.

Materials

We performed a retrospective review of our institutional HoLEP database including patients with no AC/AP usage, holding AC/AP, or continuing AC/AP through surgery. Hemostasis time was calculated as analogous to OR time not dedicated to enucleation or morcellation. Grams enucleated per minute, total laser-energy usage (kJ), and laser-energy per gram of tissue enucleated were also analyzed to evaluate operative efficiency.

Results

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We included 621 patients who underwent HoLEP from July 2018 to August 2022; 49 continued AC/AP through surgery, 101 held preoperatively, and 471 had no AC/AP usage. There was no difference in hemostasis time between those continuing AC/AP, patients holding these medications, and non-anticoagulated patients (19.12 vs. 18.16 vs. 18.93; p=0.825). There was no difference in mean total energy used (120.25 vs. 120.25 vs. 121.09; p=0.992) or kJ/gram enucleated among the groups (3.58 vs. 2.47 vs. 2.71; p=0.092). However, mean enucleated grams/minute was different among the groups (1.25 vs. 1.44 vs. 1.64; p=0.016). OR specimen weight was different in those who continued AC/AP and those with no AC/AP usage (54.29 vs. 77.46; p=0.017).

Conclusion

HoLEP is safe and equally efficient for patients who require AC or AP therapy. While enucleation efficiency was different between the groups, there was no statistically significant difference in operative efficiency in those who continued or discontinued AC/AP.

Funding

None

Co-Authors

Cameron McClaine,
Indiana University School of Medicine

Abigail Beard,
Indiana University School of Medicine

Thomas Murphy,
Indiana University School of Medicine

RJ Caras, DO
Indiana University School of Medicine

Austen Slade, MD
Indiana University School of Medicine

Marcelino Rivera, MD
Indiana University School of Medicine