Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 Nov 9;10(12):437-443.
doi: 10.1177/1756287218811037. eCollection 2018 Dec.

New oral anti-coagulation drugs and prostate biopsy: a call for guidelines

Mathieu Coscarella  1 , Serge Motte  2 , Mohamad-Fadi Dalati  3 , Tania Oliveira-E-Silva  3 , Kim Entezari  3 , Thierry Roumeguere  4
Affiliations
Review

New oral anti-coagulation drugs and prostate biopsy: a call for guidelines

Mathieu Coscarella et al. Ther Adv Urol. .

Abstract

Background: Prostate biopsy is a rather frequent procedure, mostly performed in outpatient settings. Bleeding complications following this procedure require precise and delicate management of pre-, peri- and post-procedure anti-coagulation treatments. New oral anti-coagulation drugs (NOACs) are increasingly used. However, the management of such treatments is feared and not yet well known to urologists. A protocol for prostate biopsy management of NOACs seems mandatory.

Materials and methods: A review of the literature, using Pubmed and Cochrane databases, together with analysis of several medical associations' recommendations in urology, anaesthesiology, cardiology, oncology and drug safety agency, was performed.

Results: There are no recommendations about NOAC management for prostate biopsy available from scientific societies. There is also a lack of specific urological studies. However, several panels of expert recommendations could be helpful in establishing standardized protocols adapted from surgery to prostate biopsy. With the growing use of NOACs, recommendations have shifted to continue anti-coagulant treatment without bridging NOACs for low bleeding risk procedures such as prostate biopsy, in carefully selected groups of patients.

Conclusion: Extensive indications coupled with the ease of use of NOACs contribute significantly to the widespread replacement of traditional vitamin K antagonist. Knowing that heparin bridging leads to more bleeding, and in the pursuit of more autonomy and safety, urologists should be able to propose dedicated anti-coagulant management using NOACs adapted to carefully selected patients before the prostate biopsy procedure. Further studies and guidelines specific to the concept of non-bridging for anti-coagulant-requiring patients are mandatory for this routine procedure.

Keywords: complications; new oral anti-coagulant (NOAC); prostate biopsy.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest statement: The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Last intake of NOAC before prostate biopsy. A, apixaban; D, dabigatran; E, edoxaban; PB, prostate biopsy; R, rivaroxaban.
See this image and copyright information in PMC

References

    1. Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009; 361: 1139–1151. - PubMed
    1. Barnes GD, Lucas E, Alexander GC, et al. National trends in ambulatory oral anticoagulant use. Am J Med 2015; 128: 1300–1305. - PMC - PubMed
    1. Benjamin EJ, Virani SS, Callaway CW, et al. Heart disease and stroke statistics – 2018 update: a report from the American Heart Association. Circulation 2018; 137: e67–e492. - PubMed
    1. Steinberg BA, Peterson ED, Kim S, et al. Use and outcomes associated with bridging during anticoagulation interruptions in patients with atrial fibrillation: findings from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). Circulation 2015; 131: 488–494. - PMC - PubMed
    1. Gupta A, Streiff M, Resar J, et al. Stent management in elective genitourinary surgery. BJU Int 2012; 110: 480–484. - PubMed

LinkOut - more resources