Risk of Bleeding Complications after Preoperative Antiplatelet Withdrawal versus Continuing Antiplatelet Drugs during Transurethral Resection of the Prostate and Prostate Puncture Biopsy: A Systematic Review and Meta-Analysis

OBJECTIVE: To systematically evaluate the risk of antiplatelet drugs (APs) on bleeding complications in urological surgery. METHODS: Studies were sought and included in this review if they were clinical controlled trials and involved transurethral resection of the prostate (TURP) and prostate puncture biopsy (PPB), which compared preoperative AP withdrawal (control group) with continuing APs (experimental group) and revealed bleeding complications as outcomes. A literature search was conducted of the electronic databases PubMed, Ovid, ScienceDirect and Embase for studies published between 1990 and 2012. Two reviewers independently screened the studies for eligibility, evaluated the quality and extracted the data from the eligible studies, with confirmation by cross-checking. There was evidence of publication bias based on Egger's test and funnel plot. Data were processed using Cochrane Review Manager 5.0 software. RESULTS: Nine studies involving 3,145 cases met the inclusion criteria and were included in the meta-analysis. The baselines of patients' characteristics were comparable in all studies. The meta-analysis results showed that no differences were found in risk of bleeding after (1) TURP (OR 1.26, 95% CI 0.80-2.00, p = 0.32) or (2) PPB (OR 0.89, 95% CI 0.45-1.76, p = 0.73). CONCLUSION: Preoperative APs do not raise the risk of surgical bleeding complications in prostatectomy and PPB. Because of few studies and small samples, more high-quality trials with larger samples and longer follow-ups are proposed.