Background: Transurethral resection of the bladder (TURB) harbors a high-risk for postoperative bleeding, especially in patients requiring anticoagulation. Recently, direct oral anticoagulants (DOACs) have become a popular alternative to vitamin K antagonists (VKAs), though their impact on TURB complications remains unclear.
Objectives: To assess the postoperative complications of TURB from patients taking DOACs and VKAs.
Design: Retrospective cohort study.
Materials and methods: We retrospectively identified anticoagulated patients undergoing a TURB at our institution between 2012 and 2022 and divided them into two groups: whether they received VKA or DOAC. Follow-up of each patient was performed for 3 months. Occurrence and time to event of postoperative bleeding and thromboembolic events were recorded. A multivariable regression analysis was performed to assess risk differences.
Results: A total of 167 patients (11.7%) fulfilled the inclusion criteria, of which 102 patients (61.1%) received a DOAC and 65 patients (38.9%) a VKA. Postoperative bleeding led to re-catheterization in 13 (12.8%) DOAC and 6 (9.2%) VKA patients (p = 0.49) and re-intervention in 7 (6.9%) DOAC and 4 (6.2%) VKA patients (p = 0.86). Blood transfusions were administered to 3 DOAC patients (2.9%), none in the VKA group. No thromboembolic events were reported.
Conclusion: TURB carries low morbidity in anticoagulated patients. Thromboembolic events and the need for blood transfusion are infrequent. No substantial difference between the postoperative bleeding risk of patients receiving DOAC or VKA was found. All bleeding complications occurred within 2 weeks, marking it a potentially safe point in time to restart the OAC thereafter.
Keywords: anticoagulation; atrial fibrillation; postoperative bleeding; thromboembolism.
Risk of postoperative bleeding and thromboembolic events in anticoagulated patients undergoing transurethral resection of bladder tumors.
Background: Transurethral resection of the bladder (TURB) is a surgery with a high risk of bleeding after the operation, especially for patients who take blood-thinning medications (anticoagulants). Recently, newer anticoagulants called direct oral anticoagulants (DOACs) have become popular instead of the older vitamin K antagonists (VKAs), but it’s not clear how these newer drugs affect complications after TURB.
Objectives: This study aims to compare the complications after TURB in patients taking either DOACs or VKAs.
Study design: Retrospective Analysis of patient data.
Materials and methods: The study reviewed records of patients on anticoagulants who had TURB at our institution between 2012 and 2022. Patients were divided into two groups based on whether they took VKAs or DOACs. Each patient was followed up for 3 months after the surgery. The researchers recorded how often and when bleeding and clotting events happened after surgery.
Results: 167 patients met the study criteria: 102 on DOACs and 65 on VKAs. Bleeding after surgery required re-catheterization in 13 patients (12.8%) on DOACs and 6 patients (9.2%) on VKAs, showing no significant difference. Re-intervention was needed for bleeding in 7 patients (6.9%) on DOACs and 4 patients (6.2%) on VKAs, also showing no significant difference. Blood transfusions were needed in 3 patients (2.9%) on DOACs and none on VKAs. No clotting events were reported.
Conclusions: TURB is generally safe for patients on anticoagulants, with low rates of serious complications. There was no significant difference in the risk of postoperative bleeding between patients taking DOACs and those taking VKAs. All bleeding complications happened within 2 weeks after surgery, suggesting that it might be safe to restart blood thinners after this period.
© The Author(s), 2025.