Oral anticoagulation (OA) is considered a strict contraindication to transurethral resection of the prostate (TURP). In recent years, however, safe and effective surgical alternatives such as holmium laser enucleation of the prostate (HoLEP) have emerged. Evidence from randomized trials has revealed that HoLEP has fewer bleeding complications than TURP, suggesting that HoLEP in anticoagulated patients is safer than TURP. However, published data evaluating bleeding complications in anticoagulated patients undergoing HoLEP are incomplete. Using a retrospective design, this is the first study to compare the bleeding complication rates of anticoagulated patients undergoing HoLEP to patients not on OA.We reviewed the electronic medical records of the first 76 HoLEP patients treated by a single urologist in two New England hospitals from May 2002 to September 2007.Thirty-nine were on OA, and 37 were controls. Thirteen patients were on coumadin (mean international normalized ratio [INR] 1.5), and 25 were on aspirin at the time of their surgery. Among the patients on OA, 8% (n = 2) had intraoperative hematuria compared to 14% (n = 5) of controls (p = 0.25). No patients in either group required blood transfusions. Stratifying the OA population revealed no statistical differences in bleeding complication rates between the coumadin, aspirin, and control groups (p = 0.34). Additionally, there were no differences in standard postoperative outcomes.These findings suggest that HoLEP has excellent hemostatic properties in high-risk patients and is a safe surgical alternative to TURP in patients on OA.