Aspirin, a silent risk factor in urology.

Aspirin is a widely used drug for its analgetic, antiinflamatory and antipyretic effects as well as for prophylactic effect in cardiovascular diseases. However, an increased number of operative hemorrhagic complications in patients on daily aspirin have been reported, an adverse effect highly relevant in urology. In this review the normal hemostatic mechanism and the chief pharmacological effect of aspirin on hemostasis is described. The literature is reviewed for hemorrhagic complications to aspirin in urology. Few reports indicate that aspirin increases bleeding and need for transfusion following prostatectomy, but no placebo-controlled clinical trials with large patient groups have been carried out. Following prostate biopsy and extracorporeal shock wave lithotripsy aspirin-induced hemorrhagic complications have been reported. Cessation of aspirin ingestion one week prior to invasive urologic procedures and correction of bleeding complications with desmopressin, platelet concentration or fresh whole blood is described.