The Effect Of Haemorrhage To Transurethral Resection Of Prostate During Taking The Asprin Perioperation

BackgroundAcetylsalicylic acid (ASA) is a widely used drug in the prevention of cardiovascular disease due to its inhibitory effect on platelet aggregation. It has convincingly been demonstrated that ASA reduces the risk of cardiovascular death or subsequent attacks in patients with previous myocardial infarction, unstable angina, stroke or transient ischaemic attacks. However, one adverse effect of AS A treatment is an increased risk of bleeding. Shahar et al estimated that about25%of elderly patients should be on aspirin and many patients require lifelong therapy. When used for secondary prevention, the withdrawal of aspirin is associated with a three-fold increase (odds ratio3.14) in the risk of myocardial infarct and death; and for patients with coronary stents the risk is increased almost90-fold (odds ratio89.87).The timing of these cardiovascular events has been examined in two separate studies and has been shown to occur an average of8.5and10.7days post aspirin discontinuation, approximately the lifespan of a platelet.Turp(transurethral resection of prostate, Turp) is a common urological procedure which can be associated with considerable blood loss. The general consensus of urologists is that antiplatelet therapy increases blood loss, and as a consequence a large number of patients are instructed to withhold all antiplatelet therapy during the perioperative period. Recent surveys indicate that this is often done routinely, irrespective of the indication for antiplatelet therapy, and is also seen by a large number of urologists as an absolute contraindication to surgery.Current recommendations warn against ceasing antiplatelet medications especially when used for secondary prevention and in patients with coronary stents. however, the actual perioperative management of these patients presenting with an indication for Turp varies widely. For patients taking warfarin the situation is similar. Perioperative management of antiplatelet and anticoagulant agents remains highly variable. The question to be considered for these patients is whether the risk of perioperative haemorrhage associated with continuing antiplatelet and anticoagulant therapy outweighs the increased thromboembolic risks and the subsequent morbidity associated with withholding them.For this reason, this study summarizes effect of aspirin on bleeding caused by transurethral resection of prostate on the basis of existing medical records, so as to provide scientific basis for surgeons to justify whether or not to stop patients using anticoagulant drugs in the perioperative period of Turp.Objectivesstudying the effect to transurethral resection of prostate during taking the asprin perioperation.Subjects and MethodsObjects of this study were selected from patients treated with TURP in urinary surgery of the people’s hospital of Gaomi, Jiaozhou central hospital and the people’s hospital of Jiaonan during the period of Jan2012to Dec2013.All the data are medical records,361cases of patients were selected in this study, these patients were divided into3groups according to aspirin taking situations in the past perioperative period.50cases were selected in Group1:aspirin group (aspirin was used in the perioperative period),86cases were selected in Group2:stop taking group (aspirin was stopped for10days before operation and in the perioperative period),225cases were selected in Group3:aspirin or anticoagulant drugs were unused.We collected the indicators of research subjects:The general characteristics of the object of study:age, profession, income, health care, height of a person, weight.Living habits:whether smoke or not, nitial smoke time, daily smoke amount, whether drink or not, initial drink time, drink type, daily drink amount.Aspirin use:history of taking aspirin, the daily dose of aspirin.Other medical history of research objects:whether their liver function normal or not, whether they suffered from hypertension or not, pressure value, cardiac function, serum creatinine (value), whether they suffered from hydronephrosis or not, whether they suffered from diabetes or not, whether they suffered from chronic obstructive pulmonary diseases or not, whether they have myocardial infarction medical history or not, whether they have used other anticoagulant drugs or not, whether they have stroke medical history or not.Prostate hyperplasia and related symptoms:history of bladder calculi, history of hematuresis, history of urinary tract infection, whether inserting catheter after preoperative, prostate volume etc. The indicators during and post operation:the weight of prostate, operating time, intraoperative complications, intraoperative bleeding amount, postoperative bleeding amount, the time of bladder irrigation and so on.We applied generalized linear regression analysis to control possible confounding factors related to explore the impact of numerical indicator variable factors.Results:1. Influence factors of intraoperative bleeding amount were analyzed, single factor analysis showed that, bleeding amount was positively related to prostate volume, resected prostate weight and operation time,p<0.0001; bleeding amount was negatively related to preoperative repeated hematuresis, p<0.05. multiple-factor analysis showed that, compared to the other two groups, intraoperative bleeding amount of drug taking group had no difference.2. Influence factors of postoperative bleeding amount were analyzed, single factor analysis showed that, bleeding amount might be negatively related to annual income of the family,p=0.0005; bleeding amount was positively related to prostate volume, resected prostate weight, operation time, intraoperative bleeding amount, cardiac dysfunction, whether they have indwelling catheter or not,p value:p<0.0001,0.0001,<0.0001,<0.0001,<0.0001,0.0117. Multiple-factor analysis showed that, compared to aspirin group, postoperative bleeding amount of aspirin unused group reduced by67.3138ml,p<0.0001, compared to aspirin group, postoperative bleeding amount of drug stopping group reduced by73.3138ml,p<0.0001.3. Influence factors of irrigation stop time were analyzed, single factor analysis showed that, irrigation stop time might be negatively related to annual income of the family, p<0.0l; irrigation stop time was positively related to prostate volume, resected prostate weight, operation time, intraoperative bleeding amount, postoperative bleeding amount, whether they have cardiac dysfunction or not. Multiple-factor analysis showed that, irrigation stop time of aspirin unused group was similar with that of aspirin group, irrigation stop time of drug stopping group was similar with that of aspirin group.Conclusions:For patients suffered from transurethral resection of prostate, intraoperative bleeding amount and bladder irrigation stop time of aspirin group are similar with that of aspirin stopping group and aspirin or anticoagulant drug unused group. Postoperative bleeding amount of perioperative aspirin treatment group is more than that of the other two groups.Suggestions:Since postoperative bleeding amount of perioperative aspirin treatment group has no obvious clinical significance, it is considered that aspirin treatment can prevent clinical significance, so the author advises patients treated with transurethral resection of prostate not to stop using prophylactic dose aspirin.