Continuation versus Discontinuation of High and Low Dose Aspirin Prior to Transrectal Ultrasound-Guided Prostate Biopsy: A Comparison of Cardiovascular Morbidity and Duration of Bleeding

Transrectal Ultrasound (TRUS)-guided 12-core prostate biopsy sampling remains the most common utilized technique for diagnosing prostate cancer. There are limited randomized controlled studies assessing the effect of continuing aspirin on bleeding complications post prostate biopsy and none that assess cardiovascular morbidity following prostate biopsy. Our goal is to conduct a randomized controlled trial comparing the severity and duration of bleeding complications between patients continuing or discontinuing low or high dose aspirin therapy, and to assess post-biopsy cardiovascular morbidity in these patients. 65 veterans undergoing TRUS-guided prostate biopsy and on daily aspirin of 81 mg or 325 mg were randomized to continue or hold their aspirin regimen prior to biopsy. There was no significant difference in the mean duration of minor bleeding events in patients who continued their aspirin regimen compared to patients who discontinued their aspirin regimen or in patients who continued low dose aspirin compared to patients who continued high dose aspirin. No short term or long-term cardiovascular events were identified in the groups that discontinued low and high dose aspirin. It is likely prudent to continue 81 mg of aspirin as the risk of post TRUS prostate biopsy bleeding does not outweigh the benefit of cardiovascular protection. It is difficult to strongly conclude that there is no increased risk of bleeding with continuation of 325 mg of aspirin prior to biopsy due to our sample size and exclusion criteria, however this study's recruitment implies that there is only a small subgroup of the general population who are taking 325mg of aspirin.