title: Safety and efficacy of percutaneous nephrostolithotomy in patients on anticoagulant therapy.
abstract: OBJECTIVE
  We assessed the safety and efficacy of percutaneous nephrostolithotomy in patients requiring long-term anticoagulant therapy.
  
  
  METHODS
  We reviewed the records of 792 patients undergoing percutaneous nephrostolithotomy at our institution from 2000 to 2007, and identified 27 on anticoagulation therapy (warfarin, clopidogrel or cilostazol) who underwent surgery after perioperative reversal and reinitiation of anticoagulation. Warfarin was withheld 5 days preoperatively with enoxaparin bridging and resumed 5 days postoperatively. Clopidogrel and cilostazol were stopped 10 days preoperatively and resumed 5 days postoperatively. We subsequently analyzed changes in preoperative and postoperative hemoglobin, serum creatinine and clotting parameters, as well as intraoperative and postoperative bleeding or thromboembolic complications.
  
  
  RESULTS
  Overall the stone-free rate with percutaneous nephrostolithotomy monotherapy was 93% (25 of 27 patients). A second look procedure was required in 5 patients and a third procedure was required in 1. Mean hemoglobin decrease was 1.5 gm/dl (range 0 to 4.1) and mean change in serum creatinine was 0.03 mg/dl (range 0 to 0.4). Two patients (7%) had significant bleeding and 1 (4%) had a thromboembolic complication. All complications were successfully managed conservatively or in a minimally invasive manner. All patients were stone-free at 1-month followup.
  
  
  CONCLUSIONS
  With careful perioperative regulation of anticoagulation therapy and clotting parameters, percutaneous nephrostolithotomy can be performed safely and efficiently in properly selected patients requiring long-term anticoagulation.
authors.affiliation: Stevan B. Streem Center for Endourology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Kefer
authors.forename: Burak
authors.initials: B
authors.lastname: Turna
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stein
authors.forename: Mihir M
authors.initials: MM
authors.lastname: Desai
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects*; D012307:Risk Factors
chemical_list: D000925:Anticoagulants