Percutaneous Nephrolithotomy During Uninterrupted Aspirin Therapy in High–cardiovascular Risk Patients: Preliminary Report

• Published in: Urology (Ridgewood, N.J.) Vol. 84; no. 5; pp. 1034 - 1038
• Main Authors: Leavitt, David A, Theckumparampil, Nithin, Moreira, Daniel M, Elsamra, Sammy E, Morganstern, Bradley, Hoenig, David M, Smith, Arthur D, Okeke, Zeph
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2014; Elsevier
• Subjects: Aged; Aspirin - therapeutic use; Biological and medical sciences; Blood Transfusion; Body Mass Index; Cardiovascular Diseases - complications; Cardiovascular Diseases - prevention & control; Female; Humans; Kidney Calculi - complications; Kidney Calculi - surgery; Length of Stay; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephrostomy, Percutaneous; Perioperative Period; Platelet Aggregation Inhibitors - therapeutic use; Postoperative Complications; Postoperative Period; Retrospective Studies; Risk Factors; Treatment Outcome; Urology; Human; Prostaglandin-endoperoxide synthase; High risk; Nephrology; Enzyme; Report; Enzyme inhibitor; Cardiovascular disease; Acetylsalicylic acid; Lithotomy; Antiplatelet agent; Urology; Percutaneous route; Non steroidal antiinflammatory agent; Analgesic; Treatment; Surgery; Cardiovascular risk; Antipyretic; Nephrolithotomy; Oxidoreductases; Salicylates
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2014.06.076

Objective To determine the feasibility and safety of performing percutaneous nephrolithotomy (PCNL) in high–cardiovascular risk patients remaining on aspirin therapy. Methods We retrospectively reviewed all PCNLs performed by 3 fellowship-trained endourologists at a single institution between July 2012 and January 2014. All patients remaining on aspirin for imperative indications through the day of surgery were evaluated for surgical outcomes and thromboembolic events. Results Of 281 PCNL procedures performed during the study period, 16 (5.7%) were performed in 14 patients taking aspirin, uninterrupted, through surgery. Mean surgery time was 66 minutes, mean estimated blood loss was 161 mL, and mean length of hospital stay was 2.8 days. All patients were stone free. There were no intraoperative complications. A total of 5 patients experienced a postoperative complication (n = 4, Clavien grade II; n = 1, Clavien grade IIIa). No patient experienced a perioperative thromboembolic or cardiac event. Three patients required a blood transfusion postoperatively, and none experienced delayed renal bleeding. Conclusion PCNL can be performed safely and effectively in high–cardiovascular risk patients continuing aspirin perioperatively. Compared with the potential sequelae of a thromboembolic or cardiac event, PCNL is associated with an acceptably low transfusion rate, and should be considered a viable treatment option for large renal stones in this population.