Open Access

HOW I DO IT

How I Do It: Anticoagulation management for common urologic procedures

Lydia Glick¹, Thenappan Chandrasekar¹, Scott G. Hubosky¹, Seth Teplitsky², Mihir Shah³, Joon Yau Leong¹, Geoffrey Ouma⁴, James R. Mark¹

1 Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
2 Department of Urology, University of Kentucky School of Medicine, Lexington, Kentucky, USA
3 Christiana Care Urology, Wilmington, Delaware, USA
4 Vascular Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Address correspondence to Dr. James R Mark, Department of Urology, Medical College Office, 1025 Walnut Street, Suite 1112, College Building, Philadelphia, PA 19107 USA

Canadian Journal of Urology 2020, 27(6), 10480-10487.

Abstract

Appropriate perioperative management of antithrombotic medications is critical; for every patient, the risk of bleeding must be balanced against individual risk of thrombosis. There has been a rapid influx of new antithrombotic therapies in the past 5 years, yet there is a lack of clear and concise guidelines on the management of anticoagulant and antiplatelet therapy during urologic surgery. Here we describe our approach to perioperative antithrombotic counseling, including the timing of stopping and restarting these medications. These practice guidelines have been developed in consultation with the Vascular Medicine service at our institution as well as after a review of current literature, and apply to common urologic procedures. Many cases are complex and require medical consultation or a multidisciplinary approach to management. We believe that by presenting our systematic method of antithrombotic management, including when to involve other discplines, we can increase knowledge and comfort amongst urologists in managing these medications in the perioperative period.

---

Keywords

---