Elsevier

The Journal of Urology

Adult Urology

Urolithiasis/Endourology

The Effect of Continued Low Dose Aspirin Therapy in Patients Undergoing Percutaneous Nephrolithotomy

Purpose

Aspirin is often stopped prior to percutaneous nephrolithotomy due to concern about the surgical bleeding risk. There is evidence that discontinuing aspirin perioperatively increases thromboembolic events and continuing it may be safe. We assessed the effect of continuing low dose aspirin through percutaneous nephrolithotomy and its effect on surgical and safety outcomes.

Materials and Methods

We retrospectively reviewed the records of 285 consecutive percutaneous nephrolithotomies performed between 2012 and 2015 at our institution. We compared outcomes and complications in patients who continued 81 mg aspirin daily to those in patients not receiving aspirin.

Results

A total of 67 patients (24.5%) were maintained on low dose aspirin and 207 (75.5%) were not on aspirin. The aspirin group was older (66 vs 52 years), included more tobacco users (58.2% vs 31.4%) and had a higher ASA® (American Society of Anesthesiologists®) score (2.9 vs 2.5, all p <0.001). There was no difference in mean S.T.O.N.E. (size, topography [stone location], obstruction, number of stones and evaluation of HU) score (7.6 vs 7.7, p = 0.71) or blood loss (44 vs 54 ml, p = 0.151). There was no difference in residual stone fragment size, including 0 to 2 mm in 65.3% vs 61.4% of aspirin vs no aspirin cases, 3 to 4 mm in 19.4% vs 16.2% and greater than 4 mm in 15.3% vs 22.4% (p = 0.407). Length of stay and the change in hemoglobin, hematocrit and creatinine were similar. There was no difference in the readmission rate (14.9% vs 12.6%, p = 0.618) or the total complication rate (34.4% vs 26.6%, p = 0.221). There was also no difference in the number of major complications (10.4% vs 5.8%, p = 0.193), bleeding complications (3.0% vs 2.9%, p = 0.971) and the transfusion rate (1.5% vs 1.0%, p = 0.57).

Conclusions

Percutaneous nephrolithotomy appears effective and safe in patients who continue low dose aspirin perioperatively.

Section snippets

Materials and Methods

After receiving institutional review board approval we retrospectively reviewed the charts of all patients who underwent PCNL performed by a single surgeon at our institution between February 2012 and December 2015. February 2012 was the date at which we revised our preoperative protocol for PCNL to include aspirin continuation in patients who were on low dose aspirin (81 mg once daily). Aspirin treatment was done for primary or secondary prevention of cardiovascular events as directed by the

Results

At our institution 285 consecutive patients underwent PCNL during the study period. Of these patients 67 (24.5%) were maintained on low dose aspirin therapy at the time of PCNL, including 40 (59.7%) and 27 (40.3%) for primary and secondary prevention, respectively. Table 1 lists medical comorbidities in the aspirin group.

Table 2 shows demographics in the cohort of patients on and not on aspirin therapy at PCNL. The aspirin group was older (mean age 66 vs 52, p <0.001), had a higher ASA score

Discussion

PCNL has been traditionally considered a high bleeding risk procedure due to the highly vascular nature of the kidney. Early series showed postoperative blood transfusion rates between 12% and 23%.18, 19 However, the transfusion rate in the large, contemporary Percutaneous Nephrolithotomy Global Study was significantly lower at only 5.7%.2 Based on this concern for high bleeding risk most investigators who have examined PCNL and its complications have excluded anticoagulated patients or have

Conclusions

In patients undergoing PCNL performed by an experienced surgeon continuing low dose aspirin therapy during the perioperative period appeared safe and surgical outcomes appeared to be similar to outcomes in patients not on aspirin therapy. Larger, prospective studies should be done to confirm and validate these findings.

Cited by (7)

  • Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions—Part II: Recommendations: Endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe

    2019, Journal of Vascular and Interventional Radiology

    Similar studies and recommendations are not available to establish an INR threshold. Limited data are emerging to suggest that the continuation of single-agent antiplatelet agents may be safe for certain high bleeding risk procedures such as solid organ biopsy (50,85), percutaneous endoscopic gastrostomy (PEG) (86,87), and percutaneous nephrolithotomy (88). In a cohort of 15,181 percutaneous core biopsies performed at a single institution (50), the incidence of bleeding complications in patients who had taken aspirin within 10 days of the biopsy was 0.6% (18 of 3,195), and this was not different compared with patients who had not taken aspirin (0.4%; 52 of 11,986; P = .34).

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