Anticoagulants oraux et chirurgie de l'obstruction prostatique : stopper, relayer ou poursuivre ?

The surgical management of prostatic obstruction in patients treated with oral anticoagulant (ACO) is complex due to the balance between the risk of occurrence of some haemorrhagic and thromboembolic events. The perioperative management of Vitamin K Antagonist (VKA) systematically relies on one of these 3 strategies detailed in the recommendations released by the High French Authority of Health in 2008: interrupt, relay or continue. For direct oral anticoagulant (AOD), the perioprative management relies on expert recommandations published by the Perioperative Haemostasis Group of Interest in 2015 who proposes to stop AOD without relaying. When stopping ACOs is possible, all surgical techniques and energy sources can be used. When a perioperative relay by heparin is needed, especially in the patient with a mechanical heart valve, many publications have suggested the use of lasers because of their haemostatic properties. If transurethral surgery of prostatic obstruction without ACO interruption has been reported, the level of evidence of recently published studies are still too low to alter current recommendations.