Management of patients treated with aspirin or warfarin and evaluation of haemostasis prior to prostatic biopsy: a survey of current practice amongst radiologists and urologists

Abstract

Aim: To document current practice concerning the management of patients taking aspirin or warfarin and the evaluation of haemostatic function prior to prostatic biopsy.

Method: A postal survey was performed with typed questionnaires being sent to 275 urology and 275 radiology centres.

Results: A high proportion of radiology departments in particular (83%) had protocols in place concerning the management of aspirin or warfarin prior to prostatic biopsy. A significant proportion of both radiologists and urologists have postponed biopsies due to patients unexpectedly taking these medications. Few of the respondents reported the use of pre-biopsy screening blood tests. Fifty-two percent of radiologists and 27% of urologists terminated aspirin prior to prostatic biopsy, although the urologists stopped aspirin for a long time period. Ninety-five percent of radiologists and 84% of urologists terminated warfarin prior to prostatic biopsy, although again the urologists stopped warfarin at an earlier stage. Most of those respondents who stopped warfarin prior to biopsy, also checked the INR. The urologists generally stated a higher threshold (INR) which would be considered too high to proceed.

Conclusion: There are wide variations in practice both within and between the radiology and urology groups. This is unsurprising, since there is conflicting advice in the relevant literature.