To analyze the impact of perioperative antithrombotic use on the bleeding outcomes following Aquablation.
116 men with who underwent Aquablation as part of the WATER prospective trial (NCT02505919) were assigned to 2 groups based on perioperative antithrombotic status. Antithrombotic cessation and restart timing were based on the surgeon’s discretion. Methods of achieving intraoperative hemostasis consisted of no-cautery balloon tamponade or cautery. Primary endpoints included immediate post-operative hematuria rates and changes in hemoglobin. Secondary endpoints included 90-day bleeding complications and non-bleeding post-operative adverse events.
41 men took antithrombotic medications in the perioperative period while 75 men had no antithrombotic medication. Preoperative hemoglobin levels were comparable between both groups. Post-operative hemoglobin change from baseline (drop of 1.8 ± 1.5g/dl among the antithrombotic group vs. 1.8 ± 1.7 g/dl among the antithrombotic-naïve group) did not differ between both groups (p=0.896). In total, 4 (9.8%) men in the antithrombotic group and 4 (5.3%) patients in the antithrombotic-naïve group experienced a Clavien-Dindo Grade 1 complication (p=0.451) in the 3-month postoperative period. Eight (19.5%) patients in the antithrombotic group and 11 (14.7%) patients in the antithrombotic-naïve group experienced a Clavien-Dindo Grade 2 complication (p=0.601), none of which is associated with bleeding in both groups. No men in either group demonstrated de novo erectile dysfunction. One patient (2.4%) in the antithrombotic group and none in the antithrombotic-naïve group required blood products (p=0.353).
Aquablation demonstrates comparable post-operative bleeding outcomes and other adverse effects for men with BPH who are on antithrombotic therapy.

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