In developed countries, the incidence of cardiovascular disease is increasing, therefore, anticoagulant and antiplatelet drugs are a widespread treatment nowadays. Percutaneous nephrolithotomy (PNL) is the first-line treatment for large or complex stones (> 2 cm) and remains an alternative for the smaller ones. The objective of this study is to analyze whether PNL surgery is a safe procedure in patients under a treatment discontinuation protocol for anticoagulant or antiplatelet therapies. We retrospectively studied 301 patients who underwent PNL in our hospital between 2008 and 2016 and identified 46 patients on chronic antiplatelet or anticoagulation treatment. With respect to PNL outcomes, the stone-free rate was similar (78 vs 74%, p = 0.762) in both groups, without any significant differences in the overall postoperative complications (17 vs 26%, p = 0.203). The incidence of hemorrhagic complications was similar between groups (12 vs 9%, p = 0.492), as demonstrated by the mean drop in hemoglobin (Hb), which was comparable in both cohorts (2.2 ± 1.3 vs 2.0 ± 1.4 p = 0.270) and the blood transfusion rate (14% in group A and 8% in group B, p = 0.205). No thromboembolic events were found within the year after the PNL procedure. PNL is a safe and effective intervention in patients under a treatment discontinuation protocol for anticoagulant or antiplatelet therapies. Although our study demonstrates the feasibility of this protocol, new scientific evidence aims to stratify the thromboembolic and bleeding risk of each patient to individualize the perioperative management thereafter.
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CF-B: Protocol development, data collection, data analysis, manuscript writing. DAP-F: Protocol development, data collection, data analysis, manuscript writing. JFS: Data Collection. C García: Protocol Development.
Compliance with ethical standards
Conflict of interest
DA Pérez-Fentes has financial relationship with Boston Scientific, Coloplast, Olympus, Cook, Presurgy, Palex. The rest of the authors declare that they have no conflict of interest.
Research involving Human Participants and/or Animals
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. This article does not contain any studies with animals performed by any of the authors.
Informed consent for the technique was obtained from all individual participants included in the study.
Banegas JR, Villar F, Graciani A et al (2006) Epidemiología de las enfermedades cardiovasculares. Rev Esp Cardiol 6(Supl):3G–12GGoogle Scholar
Nieto-Rodríguez JA (2009) Riesgo de enfermedad tromboembólica venosa y profilaxis en los pacientes ingresados en hospitales españoles (estudio ENDORSE). Med Clin (Barc) 133:1–7CrossRefGoogle Scholar
Cea-Calvo L, Redón J, Lozano JV et al (2007) Prevalencia de fibrilación auricular en la población española de 60 o más años de edad. Estudio PREV-ICTUS. Rev Esp Cardiol 60(6):616–624CrossRefGoogle Scholar
Hesse A, Brandle E, Wilbert D et al (2003) Study on the prevalence and incidence of urolithiasis in Germany comparing the years 1979 vs. 2000. Eur Urol 44:709CrossRefGoogle Scholar
Stamatelou KK, Francis ME, Jones CA et al (2003) Time trends in reported prevalence of kidney stones in the United States: 1976–1994. Kidney Int 63:1817CrossRefGoogle Scholar
Türk C, Petrik A, Sarica K et al (2016) EAU Guidelines on Interventional Treatment for Urolithiasis. Eur Urol Mar 69(3):475–482CrossRefGoogle Scholar
Ibarluzea G, Scoffone C, Cracco CM et al (2007) Supine Valdivia and modified lithotomy position for simultaneous anterograde and retrograde endourological access. BJU Int 100:233–236CrossRefGoogle Scholar
Singh I, Singh A, Mittal G (2008) Tubeless percutaneous nephrolithotomy: is it really less morbid? J Endourol 22:427–434CrossRefGoogle Scholar
Wezel F, Mamoulakis C, Rioja J et al (2009) Two contemporary series of percutaneous tract dilation for percutaneous nephrolithotomy. J Endourol 23:1655–1661CrossRefGoogle Scholar
Kearon C, Hirsh J (1997) Management of anticoagulation before and after elective surgery. N Engl J Med 336:1506–1511CrossRefGoogle Scholar
Spyropoulos AC, Turpie AG, Dunn AS, Spandorfer J et al (2006) Clinical outcomes with unfractionated heparin or low-molecular-weight heparin as bridging therapy in patients on long-term oral anticoagulants: the REGIMEN registry. J Thromb Haemost 4(6):1246–1252CrossRefGoogle Scholar
Cannegieter SC, Rosendaal FR, Wintzen AR et al (1995) Optimal oral anticoagulant therapy in patients with mechanical heart valves. N Engl J Med 333(1):11–17CrossRefGoogle Scholar
Cannegieter SC, Rosendaal FR, Briët E (1994) Thromboembolic and bleeding complications in patients with mechanical heart valve prostheses. Circulation Feb 89(2):635–641CrossRefGoogle Scholar
Burger W, Chemnitius JM, Kneissl GD et al (2005) Low-dose aspirin for secondary cardiovascular prevention - Cardiovascular risks after its perioperative withdrawal versus bleeding risks with its continuation—review and meta-analysis. J Intern Med 257(5):399–414CrossRefGoogle Scholar
Raval AN, Cigarroa JE, Chung MK et al (2017) Management of patients on non-vitamin K antagonist oral anticoagulants in the acute care and periprocedural setting: a scientific statement from the American heart association. Circulation 135(10):e604–e633CrossRefGoogle Scholar
Nerli RB, Reddy MN, Devaraju S et al (2012) Percutaneous nephrolithotomy in patients on chronic anticoagulant/antiplatelet therapy. Chonnam Med J 48(2):103–107CrossRefGoogle Scholar
Biondi-Zoccai GG1, Lotrionte M, Agostoni P et al (2006) A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50,279 patients at risk for coronary artery disease. Eur Heart J 27(22):2667–2674CrossRefGoogle Scholar
Kefer JC, Turna B, Stein RJ et al (2009) Safety and efficacy of percutaneous nephrostolithotomy in patients on anticoagulant therapy. J Urol 181(1):144–148CrossRefGoogle Scholar
Douketis JD, Spyropoulos AC, Kaatz S et al (2015) Perioperative bridging anticoagulation in patients with atrial fibrillation. N Engl J Med Aug 27(9):823–833 373(CrossRefGoogle Scholar
Kuo RL, Aslan P, Fitzgerald KB et al (1998) Use of ureteroscopy and holmium:YAG laser in patients with bleeding diatheses. Urology 52(4):609–613CrossRefGoogle Scholar
Turna B, Stein RJ, Smaldone MC et al (2008) Safety and efficacy of flexible ureterorenoscopy and holmium:YAG lithotripsy for intrarenal stones in anticoagulated cases. J Urol 179(4):1415–1419CrossRefGoogle Scholar
Watterson JD, Girvan AR, Cook AJ et al (2002) Safety and efficacy of holmium: YAG laser lithotripsy in patients with bleeding diatheses. J Urol 168(2):442–445CrossRefGoogle Scholar