Main Article Content
Introduction: The rates of heart disease and nephrolithiasis continue to increase in the United States, and aspirin is increasingly prescribed for varying indications. Current recommendations in the urologic literature are to stop aspirin before percutaneous nephrolithotomy (PCNL); however, this is based on expert opinion. This study aims to determine the safety of PCNL performed on patients who took aspirin in the
Methods: This study was a retrospective review of 27 consecutive PCNLs for patients who took aspirin in the perioperative period (January 2013-September 2016). Pre- and postoperative hemoglobin was recorded, as were age, sex, BMI, operative duration, skin-to-stone distance, stone size, aspirin dose, aspirin indication, number of blood transfusions, and Clavien-Dindo complication classification. Correlations between hemoglobin and explanatory variables were then explored with linear regression and the Wilcoxon rank-sum test.
Results: Of the 199 PCNLs performed, 27 procedures on 23 patients were conducted without discontinuing aspirin perioperatively. Coronary artery disease was the most common indication for aspirin use (81%). Patients experienced a median hemoglobin decline of 1.4 g/dl perioperatively. No significant associations were found between hemoglobin decline and age, sex, BMI, operative duration, skin-to-stone distance, or stone size. There were no Clavien-Dindo grade III or higher complications, and no patients required a blood transfusion or angio-embolization. There were no thrombo-embolic or cardiac events in our series. Conclusions: In our single-center experience, PCNLs performed on patients taking aspirin perioperatively were not associated with the need for blood transfusion nor the occurrence of high-grade complications.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright of articles published in all DPG titles is retained by the author(s). The author(s) grants DPG the rights to publish the article and identify itself as the original publisher. The author grants DPG exclusive commercial rights to the article. The author grants any party the rights to use the article freely for non-commercial purposes provided that the original work is properly cited.
2. Ghani KR, Sammon JD, Bhojani N, et al. Trends in percutaneous nephrolithotomy use and outcomes in the United States. J Urol 2013;190:558–64.
3. Stern KL, Tyson MD, Abdul-Muhsin HM, et al. Contemporary trends in percutaneous nephrolithotomy in the United States: 1998-2011. Urology 2016;91:41–45.
4. Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics-2016 update: A report From the American Heart Association. Circulation 2016;133:e38–60.
5. Smith SC, Allen J, Blair SN, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update endorsed by the National Heart, Lung, and Blood Institute. J Am Coll Cardiol 2006;47:2130–39.
6. Riley JM, Averch TD. Stone management for the patient on anticoagulation. Curr Urol Rep 2012;13:187–89.
7. Douketis JD, Spyropoulos AC, Spencer FA, et al. Perioperative management of antithrombotic therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141:e326S-50S.
8. Culkin DJ, Exaire EJ, Green D, et al. Anticoagulation and antiplatelet therapy in urological practice: ICUD/ AUA review paper. J Urol 2014;192:1026–34.
9. Gerstein NS, Schulman PM, Gerstein WH, et al. Should more patients continue aspirin therapy perioperatively?: Clinical impact of aspirin withdrawal syndrome. Ann Surg 2012;255:811–19.
10. Leavitt DA, Theckumparampil N, Moreira DM, et al. Continuing aspirin therapy during percutaneous neph-rolithotomy: Unsafe or under-utilized? J Endourol 2014;28:1399-1403.
11. Leavitt DA, Theckumparampil N, Moreira DM, et al. Percutaneous nephrolithotomy during uninterrupted aspirin therapy in high-cardiovascular risk patients: Preliminary report. Urology 2014;84:1034–38.
12. Otto BJ, Terry RS, Lutfi FG, et al. The effect of continued low dose aspirin therapy in patients undergoing percutaneous nephrolithotomy. J Urol 2018;199:748–53.
13. Columbo JA, Lambour AJ, Sundling RA, et al. A meta-analysis of the impact of aspirin, clopidogrel, and dual antiplatelet therapy on bleeding complications in noncardiac surgery. Ann Surg 2018;167:1–10.
14. Oscarsson A, Gupta A, Fredrikson M, et al. To continue or discontinue aspirin in the perioperative period: a randomized, controlled clinical trial. Br J Anaesth 2010;104:305-12.
15. Mackinnon B, Fraser E, Simpson K, et al. Is it necessary to stop antiplatelet agents before a native renal biopsy? Nephrol Dial Transplant 2008;23:3566–70.
16. Morgan TA, Chandran S, Burger IM, et al. Complications of ultrasound-guided renal transplant biopsies. Am J Transplant 2016;16:1298–1305.
17. Leavitt DA, Keheila M, Siev M, et al. Outcomes of laparoscopic partial nephrectomy in patients continuing aspirin therapy. J Urol 2016;195:859–64.
18. Althaus AB, Dovirak O, Chang P, et al. Aspirin and clopidogrel during robotic partial nephrectomy, is it safe? Can J Urol 2015;22:7984–89.
19. Pradere B, Peyronnet B, Seisen T, et al. Impact of anticoagulant and antiplatelet drugs on perioperative outcomes of robotic-assisted partial nephrectomy. Urology 2017;99:118–22.
20. Ito T, Derweesh IH, Ginzburg S, et al. Perioperative outcomes following partial nephrectomy performed on patients remaining on antiplatelet therapy. J Urol 2017;197:31–36.
21. Packiam VT, Nottingham CU, Cohen AJ, et al. The impact of perioperative aspirin on bleeding complications following robotic partial nephrectomy. J Endourol 2016;30:997–1003.
22. de la Rosette J, Assimos D, Desai M, et al. The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: indications, complications, and outcomes in 5803 patients. J Endourol 2011;25:11–17.