Perioperative management of chronic anticoagulation therapy in urological patients: a cross-sectional survey of practice

There has been a significant increase in the volume of urological patients on daily anticoagulation therapy requiring invasive elective urological procedures.

We sought to assess whether urologists are familiar with appropriate perioperative management strategies in this patient cohort.

Urologists completed a questionnaire on their current management strategy for warfarin during the perioperative period in patients undergoing elective urological surgery. Eleven urological procedures graded as minor, endoscopic and major were assessed in the study. In addition, respondents were also asked whether they administered bridging therapy with heparin when warfarin was discontinued perioperatively.

The response rate was 52.5% (210/400). Procedure grade did not influence the duration warfarin was discontinued preoperatively with respondents discontinuing the agent 4.71 ± 1.52 days (range 2–10 days) prior to minor procedures, 4.74 ± 1.43 days (range 2–10 days) prior to endoscopic procedures and 4.88 ± 1.34 days (range 2–10 days) prior to major procedures (p > 0.05). Postoperatively, procedure grade significantly affected the day to recommencement with respondents recommencing warfarin 2.41 ± 2.31 days (range 1–14 days) after minor procedures, 3.07 ± 3.52 days (range 1–28 days) after endoscopic procedures and 4.38 ± 3.53 days (range 1–14 days) after major procedures (p < 0.0001). In total, 60 ± 0.52% of the respondents who discontinued warfarin routinely administered bridging therapy with heparin perioperatively.

Our study demonstrates variations in perioperative management practices for patients on chronic anticoagulation therapy undergoing urological procedures. Urologists should familiarise themselves with standardised guidelines if this patient subgroup are to receive optimal perioperative management.