Bleeding Events Associated With Continuing Antithrombotic Therapy During Transrectal Ultrasound‐Guided Prostate Biopsy: A Propensity Score‐Matched Analysis

OBJECTIVES: To evaluate the association between antithrombotic continuation and the frequency and severity of bleeding events during transrectal ultrasound-guided prostate biopsies. METHODS: This retrospective cohort study involved 1248 patients who underwent transrectal ultrasound-guided prostate biopsy between April 2018 and December 2024. Patients were grouped into antithrombotic(+) (continued therapy) or antithrombotic(-) (no therapy). The groups were matched 1:1 using propensity scores based on patient demographics. RESULTS: Propensity score matching yielded 162 patients per group. Mild and severe hematuria rates were comparable between the antithrombotic(+) and antithrombotic(-) groups (80.9% and 1.9% vs. 72.8% and 2.5%), with overall rectal bleeding occurring in 29.6% and 29.0%, respectively. Hematospermia rates did not differ significantly. In the unmatched direct-acting oral anticoagulant cohort, severe rectal bleeding occurred in three patients (5.7%). Multivariate analysis identified diabetes mellitus (odds ratio, 3.47, 95% confidence interval, 1.10-10.96; p = 0.034) and biopsy core number (odds ratio, 0.39, 95% confidence interval, 0.21-0.74; p = 0.004) as independent predictors of severe bleeding events. CONCLUSIONS: Transrectal ultrasound-guided prostate biopsy was generally safe without antithrombotic discontinuation, with no significant increase in bleeding events. Caution is warranted when continuing direct-acting oral anticoagulants, particularly in patients with risk factors for bleeding, such as diabetes mellitus.