Related Experiment Videos
Extracorporeal shockwave lithotripsy in patients treated with antithrombotic agents
G Zanetti1, I Kartalas-Goumas, E Montanari
1Institute of Urology, Angelo Bianchi Bonomi Haemophilia Thrombosis Centre, Ospedale Maggiore, Italy. gp.zanett@tiscalinet.it
Insights
This study found that carefully managing antithrombotic therapy in patients undergoing shock wave lithotripsy (SWL) for kidney stones can prevent complications. Modified antithrombotic protocols enable safe SWL procedures for patients on blood-thinning medications.
Area of Science:
- Urology
- Nephrology
- Cardiology
Background:
- Antithrombotic therapy poses challenges for patients requiring shock wave lithotripsy (SWL).
- Managing antithrombotic drugs in patients with kidney stones undergoing SWL is critical to prevent hemorrhagic and thromboembolic events.
Purpose of the Study:
- To evaluate the safety and efficacy of modified antithrombotic therapy protocols in patients undergoing SWL for renal and ureteral stones.
- To determine if SWL can be performed without complications in patients on antithrombotic medications.
Main Methods:
- 23 patients on antithrombotic drugs underwent SWL.
- Patients were stratified into low (Group 1) and high (Group 2) thromboembolic risk groups.
- Group 1 discontinued antiplatelet therapy; Group 2 received unfractionated heparin during therapy suspension.
Main Results:
- No hematomas or thromboembolic events were observed.
- At 3-month follow-up, 61% of patients were stone-free.
- 13% had <4-mm fragments, and 26% had >4-mm residual fragments.
Conclusions:
- Modified antithrombotic therapy protocols enable safe SWL in patients on blood-thinning medications.
- The study demonstrates the feasibility of SWL in this patient population, minimizing risks.
Patients And Methods:
Between January 1996 and December 1999, 749 patients underwent electromagnetic SWL. Among them, 23 patients, 19 with renal and 4 with ureteral stones, were receiving antithrombotic drugs (aspirin, ticlopidine, dipyridamole). According to the cardiologist and hematologist, we divided these patients into two groups: Group 1 had a low thromboembolic risk (previous myocardial infarction), and Group 2 had a high thromboembolic risk (aortocoronary bypass, atrial fibrillation, cerebrovascular disease, peripheral occlusive arterial disease). Group 1 patients discontinued their antiplatelet therapy 8 days prior to SWL to permit a sufficient number of functioning platelets to remain. Group 2 patients suspended antiplatelet therapy, and unfractioned heparin 5000 IU tid (8 a.m., 4 p.m., and 12 p.m.) was administered for the 8 days prior to SWL. On the ninth day of withdrawal, SWL was performed in all patients. Close follow-up was performed during the postoperative period (hemoglobin, hematocrit, kidney ultrasonography, plain abdominal film). The antithrombotic therapy was restored in all patients within 10 to 14 days of withdrawal.
Results:
Hematomas and thromboembolic events were not observed. At 3 months' follow-up, 14 patients (61%) were stone free, 3 (13%) had <4-mm fragments, and 6 (26%) had >4-mm residual fragments.
Conclusion:
Our schedules for the suspension or substitution of antithrombotic therapy, although tested in a small number of patients, allowed us to perform SWL without hemorrhagic or thromboembolic complications.