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Safety of percutaneous nephrolithotomy in patients on chronic anticoagulant or antiplatelet therapy

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Abstract

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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Authors and Affiliations

  1. Department of Urology, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain

    C. Fernández-Baltar, D. Pérez-Fentes, J. F. Sánchez-García & C. García-Freire

Authors
  1. C. Fernández-Baltar
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  2. D. Pérez-Fentes
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  3. J. F. Sánchez-García
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  4. C. García-Freire
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Contributions

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.

Corresponding author

Correspondence to C. Fernández-Baltar.

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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

Informed consent for the technique was obtained from all individual participants included in the study.

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Fernández-Baltar, C., Pérez-Fentes, D., Sánchez-García, J.F. et al. Safety of percutaneous nephrolithotomy in patients on chronic anticoagulant or antiplatelet therapy. Urolithiasis 46, 581–585 (2018). https://doi.org/10.1007/s00240-018-1034-1

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  • DOI: https://doi.org/10.1007/s00240-018-1034-1

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