How long should I be off anticoagulant medication before TURP?

Aspirin Discontinuation Before TURP

Stop aspirin 7 days before TURP for most patients, though continuation may be considered in select high-risk cardiovascular cases where the thrombotic risk outweighs bleeding risk. 1

Standard Aspirin Management

• Discontinue aspirin ≤7 days before TURP, following the same recommendations used for major surgical procedures with significant bleeding risk 1
• Resume aspirin 12-24 hours after surgery once adequate hemostasis is achieved 1
• TURP carries moderate to high bleeding risk, making preoperative discontinuation the standard approach for most patients 2

High-Risk Cardiovascular Patients

• For patients with drug-eluting coronary stents, consider continuing aspirin if the bleeding risk is intermediate, though TURP typically represents higher bleeding risk 1
• Patients with coronary stents or recent coronary bypass grafting are significantly more likely to continue aspirin perioperatively (62-67% in clinical practice) 3
• If surgery is elective, postpone TURP until at least 6 weeks after bare-metal stent placement or 6 months after drug-eluting stent placement 1, 2

Evidence from TURP-Specific Studies

• A retrospective study of 293 TURP patients found that 67% discontinued antiplatelet therapy an average of 7.6 days preoperatively, while 33% continued therapy 3
• Patients who continued aspirin had a 17% bleeding complication rate, compared to 4% in those who stopped aspirin and 8% in non-users 3
• More recent data from China (2023) suggests short-term preoperative discontinuation provides relatively safe surgical conditions with controllable bleeding and VTE risks 4

Critical Pitfalls to Avoid

• Do not use bridging anticoagulation (enoxaparin) for aspirin discontinuation - this dramatically increases bleeding risk to 44% and also paradoxically increases thromboembolic complications to 17% 3
• Patients may not report over-the-counter aspirin use unless specifically asked during medication reconciliation 1
• The bleeding risk significantly increases when aspirin is combined with other antiplatelet medications, anticoagulants, or NSAIDs 5, 1

Risk Stratification Algorithm

For patients on aspirin:

1. Identify the indication (primary prevention vs. secondary prevention with stents/recent MI)
2. If recent stent (<6 months drug-eluting, <6 weeks bare-metal): postpone elective TURP 1, 2
3. If stable coronary disease without recent stenting: stop aspirin 7 days preoperatively 1
4. If acute coronary event within 6 weeks: postpone surgery if possible 1
5. Resume aspirin 12-24 hours postoperatively when hemostasis is secure 1