THULLIUM LASER VAPORISATION AND ENUCLEATION OF PROSTATE IN PATIENTS ON ANTICOAGULANTS AND ANTIPLATELET AGENTS: ONE OF THE BIGGEST SERIES FROM RAMAYYA PRAMILA HOSPITALS

Significant number of patients with bladder outlet obstruction due to BPH are on antiplatelets and anticoagulants. Prostate surgery in this group of patients either in the form of TURP or Open prostatectomy is associated with increased risk of bleeding complications requiring transfusions, packing of the prostatic fossa or ligation or embolization of internal iliac arteries. 

Efficacy of Thulium Laser in the above group of patients is evaluated in terms of perioperative, postoperative and delayed bleeding complications as well as cardiac events in perioperative and immediate postoperative period. 

We Patients 217 with bladder outlet obstruction due to prostatic enlargement on antiplatelets and anticoagulants who underwent vaporisation,vaporesection or enucleation using Thullium LASER REVOLIXX . 

Ecosprin was continued in all patients and clopidogrel was stopped 48 hours before surgery in patients with prostate size of more than 70gms and restarted after 24hrs. Patients on oral anticoagulants were converted to LMWH. Patients with drug eluting coronary stents and high risk of occlusion were started on LMWH in immediate post operative period.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                

1. NO OF PATIENTS ON ASPIRIN – 112( 51.6%) 
2. NO OF PATIENTS ON CLOPIDOGREL ALONG WITH ECOSPRIN-96(44.2%) 
3. NO OF PATINETS ON ORALANTICOAGULANTS(WARFIRIN/ACETROM) - 4 ( 1.8%) 
4. LMWH - 5 (2.3%) 
5. NO OF PATINETS ON CORONARY STENTS -42(19.3%) 
6. PATIENTS WITH POST CABG STATUS 21( 9.6%) 
7. LMWH -5 (2.3%) 
8. PROSTATE Gland size 28 gms - 200gmsMean 42 gms 

Post operative Complications

1. IMMEDIATE POSTOPERATIVE BLEEDING COMPLICATIONS 7 (3.2%) 
2. Mean Hb level drop 0.7 g/dl 
3. Transfusion rate 4 (1.8%) 
4. POST OPERATIVE CARDIAC EVENT WITHIN 30DAYS 4 (1.8%) 
5. DVT & Pulmonary embolism 0 
6. DELAYED HEMATURIA WITHIN 6 MONTHS 2(0.9%)