Related Experiment Video
Updated: Jul 15, 2025
A Two-Step Method for Percutaneous Transhepatic Choledochoscopic Lithotomy
Published on: September 13, 2022
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.
Insights
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.
Objective:
To evaluate peri-operative outcomes in patients on chronic aspirin therapy undergoing percutaneous nephrolithotomy (PCNL), with and without discontinuation of aspirin. Anti-coagulation and anti-platelet therapy are contraindications for PCNL per American Urological Association guidelines due to bleeding risk. However, there is potentially increased cardiovascular risk with peri-procedural aspirin withdrawal.
Methods:
Patients on chronic aspirin undergoing PCNL between January 2014 and May 2019 were retrospectively reviewed and stratified by continued or discontinued aspirin >5 days preoperatively. Hematologic complications, transfusions, and thrombotic complications were assessed with logistic regression model.
Results:
Three hundred twenty-five patients on chronic aspirin therapy underwent PCNL-85 continued and 240 discontinued aspirin. There were no significant differences in hemoglobin change, estimated blood loss, transfusions, creatinine change, thrombotic complications, 30-days re-admissions, complications, or 30-day emergency department visits. Patients who continued aspirin had longer length of stay (1.6 vs 1.9 days, P = .03). American Society of Anesthesiologists (ASA) score of 3 (OR 3.2, P = .02, 95% confidence intervals (CI) [1.2-8.4]), ASA score of 4 (OR 4.0, P = .02, 95% CI [1.2-13.1]), Black race, and previous smoking (OR 2.1, P = .02, 95% CI [1.1-3.9]) was associated with continued aspirin. Body mass index ≥30 was associated with aspirin discontinuation (OR 0.9, P = .004, 95% CI [0.9-1.0]). Increased postoperative hematologic complications were associated with additional anticoagulation medication (OR 2.9, P = .04, 95% CI [1.0-4.4]).
Conclusion:
Continued aspirin use did not increase in postoperative complications in patients undergoing PCNL. Patients who are on additional anticoagulation medication are at risk of hematologic complications.
Related Concept Videos
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:26Cardiac Catheterization IV: Nursing Management
01:27Urinary Tract Calculi IV: Nutrition Therapy and Prevention
01:25Urinary Tract Calculi VI: Surgical Management
01:22Aneurysm IV: Nursing Management