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

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.

Authors+Show Affiliations

Academic Urology Unit, University of Aberdeen, Aberdeen, Scotland, UK. cdimitrop@gmail.com.Academic Urology Unit, University of Aberdeen, Aberdeen, Scotland, UK.Department of Anaesthesiology, University Hospital of Larissa, Larissa, Greece.Department of Anaesthesiology, University Hospital of Larissa, Larissa, Greece.Department of Medicine, McMaster University, Hamilton, ON, Canada.Department of Urology, University Hospital of Larissa, Larissa, Greece.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31938841

Citation

Dimitropoulos, Konstantinos, et al. "Perioperative Antithrombotic (antiplatelet and Anticoagulant) Therapy in Urological Practice: a Critical Assessment and Summary of the Clinical Practice Guidelines." World Journal of Urology, 2020.
Dimitropoulos K, Omar MI, 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. 2020.
Dimitropoulos, K., Omar, M. I., Chalkias, A., Arnaoutoglou, E., Douketis, J., & Gravas, S. (2020). Perioperative antithrombotic (antiplatelet and anticoagulant) therapy in urological practice: a critical assessment and summary of the clinical practice guidelines. World Journal of Urology, doi:10.1007/s00345-020-03078-2.
Dimitropoulos K, et al. Perioperative Antithrombotic (antiplatelet and Anticoagulant) Therapy in Urological Practice: a Critical Assessment and Summary of the Clinical Practice Guidelines. World J Urol. 2020 Jan 14; PubMed PMID: 31938841.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Perioperative antithrombotic (antiplatelet and anticoagulant) therapy in urological practice: a critical assessment and summary of the clinical practice guidelines. AU - Dimitropoulos,Konstantinos, AU - Omar,Muhammad Imran, AU - Chalkias,Athanasios, AU - Arnaoutoglou,Eleni, AU - Douketis,James, AU - Gravas,Stavros, Y1 - 2020/01/14/ PY - 2019/11/11/received PY - 2020/01/02/accepted PY - 2020/1/16/entrez KW - Anticoagulant KW - Antiplatelet KW - Antithrombotic KW - Guidelines KW - Perioperative KW - Surgery KW - Urological KW - Urology JF - World journal of urology JO - World J Urol N2 - 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. SN - 1433-8726 UR - https://www.unboundmedicine.com/medline/citation/31938841/Perioperative_antithrombotic_(antiplatelet_and_anticoagulant)_therapy_in_urological_practice:_a_critical_assessment_and_summary_of_the_clinical_practice_guidelines L2 - https://dx.doi.org/10.1007/s00345-020-03078-2 DB - PRIME DP - Unbound Medicine ER -