[Risk assessment of perioperative adverse events and management of antiplatelet therapy in patients with bladder cancer and coronary atherosclerotic heart disease undergoing transurethral resection of bladder cancer]

Abstract

Objective: To explore the risk factors of adverse events during the perioperative period of transurethral resection of bladder tumor (TURBT) in bladder cancer patients with coronary atherosclerotic heart disease (CAD).

Methods: We retrospectively analyzed the clinical data of bladder cancer patients who underwent TURBT in Beijing Anzhen Hospital from June 2022 to September 2024. All patients with bladder cancer and CAD underwent coronary computed tomography angiography (CCTA) for diagnosis and assessment of CAD before surgery. Based on the CCTA results, the patients with bladder cancer and CAD were divided into two groups: those with mild to moderate coronary stenosis and those with severe coronary stenosis. The severe coronary stenosis group was further divided into two subgroups based on whether they received low-molecular-weight heparin (LMWH) bridging therapy or continued their antiplatelet treatment before surgery. Perioperative anticoagulation and antiplatelet strategies were adjusted according to the opinions of the specialists. The incidence of adverse events within 30 days postoperatively was followed up and analyzed.

Results: A total of 80 bladder cancer patients with CAD who underwent TURBT were included in the study. Among the 80 patients with CAD, 55 (68.8%) had mild to moderate coronary stenosis, and 25 (31.2%) had severe coronary stenosis. Compared with those had mild to moderate coronary stenosis, the patients who had severe coronary stenosis had a higher incidence of postoperative bleeding and pulmonary embolism, although the differences were not statistically significant (P>0.05). However, the incidence of postoperative myocardial infarction was significantly higher in the patients who had severe coronary stenosis (P=0.034). Among the patients with severe coronary stenosis, 8 (32.0%) received LMWH bridging therapy before TURBT, and 17 (68.0%) continued their previous antiplatelet treatment. Compared with those who continued antiplatelet treatment, the patients who received LMWH bridging therapy had a higher incidence of postoperative bleeding and pulmonary embo-lism, although the differences were not statistically significant (P>0.05). However, the incidence of postoperative myocardial infarction was significantly higher in the LMWH bridging group (P=0.032).

Conclusion: Patients with mild-to-moderate coronary stenosis demonstrate relatively low perioperative risk during TURBT procedures and may safely undergo TURBT following antiplatelet therapy discontinuation. Conversely, those with severe coronary stenosis exhibit significantly higher perioperative risk and require intensive monitoring. In bladder cancer patients with concomitant severe coronary stenosis, perioperative LMWH bridging therapy is associated with increased myocardial infarction risk, whereas continued antiplatelet therapy does not elevate postoperative bleeding risk. Current evidence therefore supports maintaining antiplatelet therapy in these patients, with appropriate bleeding risk assessment.

Keywords: Antithrombotic drugs; Bladder cancer; Coronary atherosclerotic heart disease (CAD); Transurethral resection of bladder tumor.