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Antiplatelet and anticoagulative medication during shockwave lithotripsy
Marco J Schnabel1, Michael Gierth, Johannes Bründl
1Department of Urology, Caritas St. Josef Medical Center, University of Regensburg , Regensburg, Germany .
Journal of Endourology
|May 24, 2014
Summary
Shockwave lithotripsy (SWL) is a common treatment for kidney stones. For patients on low-dose aspirin, SWL may be a viable option, balancing bleeding risks against cardiovascular event risks.
Area of Science:
- Urology
- Nephrology
- Cardiology
Background:
- Shockwave lithotripsy (SWL) is the standard treatment for most kidney and proximal ureteral stones.
- Severe bleeding complications from SWL are rare, but bleeding diathesis is a contraindication.
- Management of anticoagulation and antiplatelet therapy during SWL has evolved, with low-dose aspirin no longer a strict contraindication for many procedures.
Purpose of the Study:
- To review the literature on managing anticoagulative and antiplatelet therapy during SWL.
- To assess the risks and benefits of SWL in patients on these medications.
Main Methods:
- A systematic literature search of Medline/PubMed was conducted.
- Included articles from urology and cardiovascular medicine journals.
Main Results:
- Literature on bleeding diathesis and SWL is limited and of low quality.
- Stopping necessary anticoagulative or antiplatelet medication increases cardiovascular adverse event (CAE) risk.
- Ureterorenoscopy is suggested for patients with bleeding diathesis, but evidence is weak.
Conclusions:
- The risk of CAE must be weighed against SWL-induced bleeding risk in patients on anticoagulants/antiplatelets.
- Low-dose aspirin users may be candidates for SWL, not automatically excluded.
- Further prospective randomized trials are needed to optimize management strategies.
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