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UPJ INSIGHT: Significant Bleeding Complications Following Transrectal Prostate Needle Biopsy
By: Jay Fuletra, MD; Chris Rjepaj, BS; Joseph Y. Clark, MD; John J. Knoedler, MD; Susan M. MacDonald, MD; Matthew G. Kaag, MD; Suzanne B. Merrill, MD; Jay D. Raman, MD | Posted on: 17 Jan 2023
Fuletra J, Rjepaj C, Clark JY, et al. Significant bleeding complications following transrectal prostate needle biopsy: incidence, predictors, and management. Urol Pract. 2023;10(1):5-9.
Study Need and Importance
Vascular disease is a leading cause of morbidity, resulting in increasing numbers of patients on chronic anticoagulation. Bleeding after transrectal prostate needle biopsy (PNB) is common, with 90% experiencing hematuria and 50% blood per rectum. We report our experiences after 2,402 PNB procedures to help delineate the incidence of significant bleeding complications.
What We Found
Seven hundred fifty-five (31%) procedures were performed on men on chronic anticoagulation therapy comprised of aspirin 81 mg (570; 75%), aspirin >81 mg (78; 10%), warfarin (57, 8%), clopidogrel (44, 6%), enoxaparin (3, 0.3%), and dipyramidole (3, 0.3%). One hundred eighty-five (7.7%) procedures were performed without cessation of these medications.
Significant bleeding regardless of anticoagulation status was reported in 65 (2.7%) of cases, and 54 of these were self-limiting and did not require a visit. The remaining 11 cases had bleeding requiring an emergency department visit and/or inpatient hospitalization. Nine cases resolved through conservative measures, while 2 required additional procedures. One case required endoscopic clipping for rectal bleeding, while the other required cystoscopy and clot evacuation for hematuria.
Procedures performed on chronic anticoagulation were not associated with increased bleeding complications (3.3% vs 2.4%, OR 1.38, 95% CI 0.83-2.28, P = .22). However, PNB procedures performed without cessation of blood thinners were associated with significantly increased likelihood of bleeding complications (5.9% vs 2.4%, OR 2.56, 95% 91 CI 1.31-4.99, P = .014; see Figure)
Limitations
One limitation is this is a single-institution, retrospective study. Secondly, we may not have captured all events, and the number of significant bleeding complications may be underreported in our data.
Interpretation for Patient Care
Transrectal PNB has a low risk of bleeding complications. Those on chronic anticoagulation who hold medication appropriately prior to biopsy do not have an increased risk of significant bleeding complications. If patients need to continue or did not appropriately hold anticoagulation, they are at increased risk of complications requiring medical attention.
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