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Is it Safe to Continue Aspirin in Patients Undergoing Percutaneous Nephrolithotomy?
Shree Agrawal-Patel1, Harmenjit Brar1, Marlie Elia2
1Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH.
Urology
|October 1, 2023
Summary
Continuing aspirin therapy during percutaneous nephrolithotomy (PCNL) did not increase postoperative complications. However, patients on additional anticoagulation medication face a higher risk of hematologic complications during PCNL.
Area of Science:
- Nephrology and Urology
- Cardiovascular Medicine
- Surgical Outcomes
Background:
- American Urological Association guidelines contraindicate anticoagulation and anti-platelet therapy for PCNL due to bleeding risks.
- Discontinuing aspirin peri-procedurally may increase cardiovascular risks for patients on chronic aspirin therapy.
- Evaluating peri-operative outcomes in patients undergoing PCNL with and without aspirin discontinuation is crucial.
Purpose of the Study:
- To assess peri-operative outcomes in patients undergoing percutaneous nephrolithotomy (PCNL) while on chronic aspirin therapy.
- To compare outcomes between patients who continued aspirin and those who discontinued it preoperatively.
- To identify risk factors associated with complications during PCNL in patients on aspirin therapy.
Main Methods:
- Retrospective review of 325 patients on chronic aspirin therapy undergoing PCNL between January 2014 and May 2019.
- Stratification of patients into two groups: continued aspirin and discontinued aspirin (>5 days preoperatively).
- Assessment of hematologic, transfusions, and thrombotic complications using logistic regression.
Main Results:
- No significant differences in hemoglobin change, estimated blood loss, transfusions, creatinine change, thrombotic complications, re-admissions, or emergency department visits between groups.
- Patients who continued aspirin had a slightly longer length of stay (1.9 vs 1.6 days, P=.03).
- Higher American Society of Anesthesiologists (ASA) scores, Black race, and previous smoking were associated with continued aspirin use; BMI ≥30 was associated with discontinuation.
- Additional anticoagulation medication increased the risk of postoperative hematologic complications (OR 2.9, P=.04).
Conclusions:
- Continued aspirin use is not associated with an increase in postoperative complications for patients undergoing PCNL.
- Patients requiring additional anticoagulation medication alongside aspirin are at a higher risk for hematologic complications.
- The findings suggest a need to re-evaluate aspirin discontinuation protocols for PCNL in select patient populations.
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