Thrombotic risk factors associated with transurethral prostatectomy

Abstract

Objective. To ascertain the potential thrombotic risk associated with transurethral prostatectomy (TURP). Patients and methods. The changes in coagulation variables were assessed in a prospective study of 40 patients undergoing TURP. Results. There was a significant increase in thrombinantithrombin complexes 6 h after TURP (ANOVA, P = 0.01) combines with a significant decrease in activated partial thromboplastin time (ANOVA, P = 0.006), suggesting a postoperative hypercoagulable state. The significant increase in D-dimer 24 h after TURP (ANOVA, P = 0.015) in the absence of any significant rise in tissue plasminogen activator antigen levels perioperatively (ANOVA, P = 0.737) suggests a physiological fibrinolytic response to the developing procoagulant state. The absence of any significant increase in plasminogen activator inhibitor-1 antigen perioperatively (ANOVA, P = 0.348) suggests the observed hypercoagulability is not due to a 'fibrinolytic shutdown' reported in other forms of surgery. Conclusion. TURP is associated with a hypercoagulable prothrombotic state; aspirin withdrawal perioperatively may be hazardous, and low-dose heparin prophylaxis for venous thrombosis should be considered.