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Percutaneous nephrolithotomy during uninterrupted aspirin therapy in high-cardiovascular risk patients: preliminary

David A Leavitt1, Nithin Theckumparampil1, Daniel M Moreira1

  • 1The Arthur Smith Institute for Urology, Hofstra North Shore-Long Island Jewish School of Medicine, New Hyde Park, NY.

Urology
|December 3, 2014
PubMed

Insights

Percutaneous nephrolithotomy (PCNL) is safe for high-cardiovascular risk patients on aspirin. This kidney stone treatment showed low complication rates and no major adverse events, making it a viable option.

Area of Science:

  • Urology
  • Nephrology
  • Cardiology

Background:

  • High-cardiovascular risk patients often require antiplatelet therapy like aspirin.
  • Discontinuing aspirin can increase the risk of thromboembolic events.
  • Percutaneous nephrolithotomy (PCNL) is a common procedure for large kidney stones.

Purpose of the Study:

  • To assess the feasibility and safety of performing PCNL in patients who continue aspirin therapy.
  • To evaluate surgical outcomes and the incidence of thromboembolic events in this patient group.

Main Methods:

  • Retrospective review of 16 PCNL procedures performed between July 2012 and January 2014.
  • Patients included were on uninterrupted aspirin therapy for imperative indications.
  • Evaluation of surgical outcomes, complications, and thromboembolic events.

Main Results:

  • 16 PCNL procedures were performed in 14 high-cardiovascular risk patients on aspirin.
  • Mean surgery time was 66 minutes, with mean blood loss of 161 mL.
  • No intraoperative complications or perioperative thromboembolic/cardiac events occurred. Postoperative complications included 4 Clavien grade II and 1 grade IIIa. Three patients required transfusion; no delayed bleeding.
  • All patients achieved stone-free status.

Conclusions:

  • PCNL can be safely and effectively performed in high-cardiovascular risk patients continuing aspirin.
  • The procedure is associated with an acceptably low transfusion rate compared to the risks of thromboembolic events.
  • PCNL is a viable treatment option for large renal stones in patients on aspirin therapy.
Abstract

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