Real World Experience Of Holmium Laser Enucleation Of The Prostate With Patients On Anticoagulation Therapy.

BACKGROUND Holmium laser enucleation of the prostate (HoLEP) is a highly effective procedure for benign prostatic hyperplasia (BPH) that is size independent and has been recommended for patients requiring antiplatelet (AP) and anticoagulant (AC) medications. Although HoLEP is feasible in AP/AC patients, there is a lack of published results on real world outcomes of patients on AP/AC therapy undergoing HoLEP. PATIENTS AND METHODS We performed a retrospective review of our institutional HoLEP database of demographics, perioperative and postoperative data and outcomes of patients on AP and AC therapy compared to none. We also further stratified patients on warfarin compared to direct oral anticoagulants (DOAC). RESULTS Of 472 patients who underwent HoLEP at our institution from July 2018 thru December 2019 with data on AP/AC drugs, 30 (6.3%) were on AP and 65 (17.2%) were on AC. One patient continued AP (3.3%), six patients (9.2%) were bridged on AC and one patient (1.5%) continued AC through the time of HoLEP at discretion of prescribing provider. Preoperatively, only age was significantly different amongst the three groups (p<0.001). There were no intraoperative differences. Postoperatively, there was a higher 90 day complication rate in AP and AC groups (p=0.035), but not an increase in Emergency Department visits (p=0.557) or Clavien3 complications (p=0.16). In comparison of patients on warfarin to DOAC, there was a lower rate of successful voiding trial (p=0.009), higher 90 day complications (p=0.003), and more Emergency Department visits (p=0.003) in the warfarin group. CONCLUSIONS HoLEP is safe and effective for patients who require AP or AC therapy. There is no increase in serious complications or worsened postoperative voiding parameters. Of patients on AC, those on DOAC have better outcomes compared to warfarin.