GreenLight laser and blood thinners

The 532 nm wavelength is preferentially absorbed by haemoglobin, which is why GreenLight vaporises vascular prostate tissue efficiently while sealing small vessels as it cuts. That property makes it a particularly useful option for men on anticoagulant or antiplatelet medication.1, 2

Why the wavelength matters

Transurethral operations involve working on a highly vascular organ. Older techniques such as monopolar TURP use a heated wire loop to cut the tissue, which can open small arteries and veins. Bleeding from these vessels is one of the main reasons TURP traditionally needed a period off anticoagulation.

The 532 nm KTP laser is absorbed mostly by haemoglobin, which heats the vascular tissue and seals small vessels in the same pass. Published series report that GreenLight can be performed in selected men on oral anticoagulants without unacceptable bleeding.2

The common blood thinners

  • Warfarin. Taken for atrial fibrillation, mechanical heart valves or recurrent thromboembolism. Monitored by INR.
  • Direct oral anticoagulants (DOACs): apixaban (Eliquis), rivaroxaban (Xarelto), dabigatran (Pradaxa). Taken for atrial fibrillation or DVT/PE.
  • Antiplatelets: aspirin, clopidogrel (Plavix, Iscover), ticagrelor (Brilinta), prasugrel. Taken after coronary stents, stroke or vascular bypass.

How the decision is made

The choice about whether to pause, reduce, bridge or continue a blood thinner before GreenLight is a shared decision between Dr Kooner, the anaesthetist, and whichever specialist prescribed the medication (cardiologist, haematologist, neurologist, vascular surgeon). The factors considered include:

  • Why the anticoagulant was started.
  • Thromboembolic risk if it is paused.
  • Bleeding risk if it is continued.
  • Prostate size and the expected operating time.
  • Whether a period of bridging with a short-acting agent is appropriate.
Do not stop or change any blood thinner on your own. Stopping warfarin, DOACs, clopidogrel or aspirin can have serious consequences, especially in the first months after a coronary stent, stroke or prosthetic valve surgery. Always discuss the plan with the doctor who prescribed it and with Dr Kooner's rooms.

What to bring to the consultation

  • A list of every medication you take, including over-the-counter aspirin and fish-oil style supplements.
  • The name of the specialist who started the anticoagulant.
  • Recent INR results if you are on warfarin.
  • Recent blood count (haemoglobin and platelets) if available.

Recovery on blood thinners

After GreenLight, the catheter period (typically 24 to 48 hours) and the first two weeks can involve some blood-tinged urine as the vaporised surface heals. This is usually mild and settles with hydration. If you are on a blood thinner, Dr Kooner and the anaesthetist will decide when it is safe to restart and in what dose. Firm instructions are given in your discharge letter.

Request a second opinion What to expect, full timeline

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