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Perioperative antithrombotic (antiplatelet and anticoagulant) therapy in urological practice: a critical assessment and summary of the clinical practice guidelines

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Abstract

Purpose

The perioperative management of patients who are receiving antithrombotic (antiplatelet or anticoagulant) therapy and require urologic surgery is challenging due to the inherent risk for surgical bleeding and the need to minimize thromboembolic risk. The aim of this review is to assess the quality and consistency of clinical practice guidelines (CPGs) and clinical practice recommendations (CPRs) on this topic, and to summarize the evidence and associated strength of recommendations relating to perioperative antithrombotic management.

Methods

A pragmatic search of electronic databases and guidelines websites was performed to identify relevant CPGs/CPRs. The AGREE II (Appraisal of Guidelines for REsearch and Evaluation) instrument was used to assess the methodological quality and integrity of the CPGs.

Results

The CPGs provided by the European Association of Urology (EAU), the American College of Chest Physicians (ACCP) and the European Society of Cardiology/European Society of Anaesthesiology (ESC/ESA), and the CPRs provided by the International Consultation on Urological Disease (ICUD)/American Urologic Association (AUA) were retrieved and reviewed. The 3 CPGs were critically assessed using the AGREE II instrument. Inconsistent recommendations were provided based on the indication for antithrombotic medication, the antiplatelet/anticoagulant agent and the type of urological procedure. Based on the AGREE II tool for CPG assessment, the EAU CPGs scored higher (83.3 points) compared to the ESC/ESA (75 points) and ACCP CPG (66.7 points).

Conclusion

The perioperative management of antithrombotic therapy in urological patients is potentially challenging but inconsistent CPG of varying quality may create uncertainty as to best practices to minimize thromboembolic and bleeding risk.

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Authors and Affiliations

  1. Academic Urology Unit, University of Aberdeen, Aberdeen, Scotland, UK

    Konstantinos Dimitropoulos & Muhammad Imran Omar

  2. Department of Anaesthesiology, University Hospital of Larissa, Larissa, Greece

    Athanasios Chalkias & Eleni Arnaoutoglou

  3. Department of Medicine, McMaster University, Hamilton, ON, Canada

    James Douketis

  4. Department of Urology, University Hospital of Larissa, Larissa, Greece

    Stavros Gravas

Authors
  1. Konstantinos Dimitropoulos
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  2. Muhammad Imran Omar
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  3. Athanasios Chalkias
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  4. Eleni Arnaoutoglou
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  5. James Douketis
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  6. Stavros Gravas
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Contributions

KD: protocol/project development, data collection or management, data analysis, and manuscript writing/editing. MIO: protocol/project development, data collection or management, data analysis, and manuscript writing/editing. AC: data collection or management and manuscript writing/editing. EA: data collection or management and manuscript writing/editing. JD: protocol/project development, data collection or management, and manuscript writing/editing. SG: protocol/project development, data collection or management, and manuscript writing/editing.

Corresponding author

Correspondence to Konstantinos Dimitropoulos.

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Conflict of interest

No financial conflicts of interest. K. Dimitropoulos is a Senior Associate of the EAU Guidelines Office and a member of the EAU Guidelines Office Urethral Strictures panel, M.I. Omar is the EAU Guidelines Office Methodology Supervisor, S. Gravas is the Chair of the EAU Guidelines Office Male LUTS panel and J. Douketis is the first author of the ACCP Guidelines publication.

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Dimitropoulos, K., Omar, M.I., Chalkias, A. et al. Perioperative antithrombotic (antiplatelet and anticoagulant) therapy in urological practice: a critical assessment and summary of the clinical practice guidelines. World J Urol 38, 2761–2770 (2020). https://doi.org/10.1007/s00345-020-03078-2

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  • DOI: https://doi.org/10.1007/s00345-020-03078-2

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