title: Thromboprophylaxis and bleeding diathesis in minimally invasive stone surgery.
abstract: With populations ageing and active treatment of urinary stones increasingly in demand, more patients with stones are presenting with an underlying bleeding disorder or need for regular thromboprophylaxis, by means of antiplatelet and other medication. A practical guide to thromboprophylaxis in the treatment of urinary tract lithiasis has not yet been established. Patients can be stratified according to levels of risk of arterial and venous thromboembolism, which influence the requirements for antiplatelet and anticoagulant medications, respectively. Patients should also be stratified according to their risk of bleeding. Consideration of the combined risks of bleeding and thromboembolism should determine the perioperative thromboprophylactic strategy. The choice of shockwave lithotripsy, percutaneous nephrolithotomy or ureteroscopy with laser lithotripsy for treatment of lithiasis should be determined with regard to these risks. Although ureteroscopy is the preferred method in high-risk patients, shockwave lithotripsy and percutaneous nephrolithotomy can be chosen when indicated, if appropriate guidelines are strictly followed.
authors.affiliation: Endourology and Stones Services, Barts Health NHS Trust, 9th Floor, Royal London Hospital, Whitechapel, London E1 1BB, UK.
authors.forename: Andreas
authors.initials: A
authors.lastname: Bourdoumis
authors.affiliation: Department of Urology, North Devon District Hospital NHS Trust, Barnstaple, North Devon EX31 4HX, UK.
authors.forename: Theodora
authors.initials: T
authors.lastname: Stasinou
authors.affiliation: Endourology and Stones Services, Barts Health NHS Trust, 9th Floor, Royal London Hospital, Whitechapel, London E1 1BB, UK.
authors.forename: Stefanos
authors.initials: S
authors.lastname: Kachrilas
authors.affiliation: 2nd Department of Urology, School of Medicine, University of Athens, Sismanoglio General Hospital, 1 Sismanogleiou Street, 14578 Athens, Greece.
authors.forename: Athanasios G
authors.initials: AG
authors.lastname: Papatsoris
authors.affiliation: Endourology and Stones Services, Barts Health NHS Trust, 9th Floor, Royal London Hospital, Whitechapel, London E1 1BB, UK.
authors.forename: Noor
authors.initials: N
authors.lastname: Buchholz
authors.affiliation: Endourology and Stones Services, Barts Health NHS Trust, 9th Floor, Royal London Hospital, Whitechapel, London E1 1BB, UK.
authors.forename: Junaid
authors.initials: J
authors.lastname: Masood
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control*; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D015912:Thrombolytic Therapy / Q000379:methods*; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control*