This retrospective study included 378 patients presenting with LUTS and large prostate. They underwent HoLEP procedure between December 2016 and July 2020. Based on the use of anticoagulant agents, patients were divided into three groups. While patients receiving acetylsalicylic acid and platelet aggregation inhibitors were grouped as AP, patients receiving new oral anticoagulants (NOAC) as well as those bridged with low molecular weight heparin (LMWH) as a substitution for Vitamin K antagonists were grouped as AC. Lastly, patients who did not receive AT were in the last one as the non-treatment (NT) group. Patient characteristics, perioperative, and postoperative outcomes were well recorded in all cases.

The difference between the Hemoglobin (Hb) values measured one day before the surgery and the values measured at 12 hours and 1 week postoperatively was defined as ”hemoglobin decrease within 12 hours after surgery” and ”hemoglobin decrease at 1-week postoperatively”, respectively. Since we initiated AC medication within 24 hours after HoLEP procedure, we thought it would be appropriate to evaluate the effect of AC on Hb decrease with ”hemoglobin decrease at 1-week postoperatively”. The enucleation and morcellation efficiency were calculated as the ratio of the removed tissue volume to the enucleation-morcellation time. Functional data were obtained from the post-op follow-up records of 337 patients referring to our clinic for the 3rd-month postoperative follow-up evaluation. Data for 41 patients were not available their relevant recordings were excluded from evaluation.

A single surgeon performed all the surgeries in the present study. Enucleation of the prostate adenomas was made as two or three lobes techniques depending on the prostate morphology (with/without huge median lob). The equipment included a 100W Holmium laser (Versapulse, Lumenis Inc., Santa Clara, CA, USA), 550-um end-firing flexible fiber, a 26fr continuous flow laser resectoscope (Karl- Storz, Germany), 26fr nephroscope, and morcellator (Versacut; LumenisInc). The standard laser setting was adjusted as 1.2J and 50Hz.

Patients, receiving vitamin K antagonists stopped taking the medication for 5 days before HoLEP and were bridged with low molecular weight heparins (LMWH) during the perioperative period. Patients taking NOAC stopped taking medication 48-72 h before surgery. In the AP group, patients receiving acetylsalicylic acid and platelet aggregation inhibitors were operated under acetylsalicylic acid treatment. In patients who underwent surgery, INR was <1.7. The treatments of the patients who received AC were resumed within 24 hours postoperatively.

All statistical analyses were performed with SPSS 25.0.0.1 software (IBM Corp., Armonk, NY, USA) with the Mann-Whitney U, Kruskal–Wallis test, chi-squared test, and Wilcoxon signed-rank test. Normal distribution assumption for continuous variables was analyzed with the Shapiro-Wilk test. A value of p<0.05 was considered statistically significant.