关键词: 膀胱癌, 经尿道膀胱肿瘤切除术, 冠状动脉粥样硬化性心脏病, 抗血栓药物

Abstract: The decision⁃making process for the comprehensive treatment of cancer patients with concurrent  cardiovascular diseases remains in the preliminary exploration phase. Taking transurethral resection of bladder tumor (TURBT) in bladder cancer patients with concomitant coronary atherosclerotic heart disease (CAD) as an example, the choice of perioperative antiplatelet therapy poses a clinical dilemma: discontinuing antiplatelet therapy elevates the risk of perioperative adverse cardiovascular events, while continuing antiplatelet therapy increases the likelihood of surgical bleeding. For an extended period, bridging therapy with anticoagulants such as low⁃molecular⁃weight heparin (LMWH) has been routinely administered preoperatively to patients on antiplatelet treatment. However, anticoagulants and antiplatelet agents exert distinct mechanisms on the coagulation system, and there is currently a paucity of high⁃quality evidence. Based on recent research findings, this article proposed the following perspective: For patients with mild⁃to⁃moderate coronary artery stenosis, no history of percutaneous coronary intervention (PCI), and who are scheduled to undergo TURBT, those with low thromboembolic risk and moderate surgical bleeding risk, discontinuing their prior antiplatelet therapy. In contrast, for patients with severe coronary artery stenosis, a history of PCI, and who are planned for TURBT, those with high thromboembolic risk and moderate surgical bleeding risk, continuing the previous antiplatelet therapy or implementing bridging therapy with short⁃acting antiplatelet agents may represent a more rational clinical decision.

Key words: Bladder cancer, Transurethral resection of bladder tumor, Coronary atherosclerotic heart disease, Antithrombotic drugs