Continuing aspirin therapy during percutaneous nephrolithotomy: unsafe or under-utilized?
BACKGROUND
Aspirin, as an inhibitor of platelets, is traditionally discontinued prior to percutaneous nephrolithotomy (PCNL) given the concern for increased surgical hemorrhage. However, this practice is based on expert opinion only, and mounting evidence suggests holding aspirin perioperatively can be more harmful than once thought. We sought to compared PCNL outcomes and complications in patients continuing aspirin to those stopping aspirin perioperatively.


METHODS
A retrospective review was performed of 321 consecutive PCNLs done between July 2012 and March 2014. Patients were separated into two groups. The on-aspirin group consisted of patients continuing aspirin throughout the perioperative period. The off-aspirin group had aspirin held temporarily pre- and postoperatively. Surgical outcomes and complications were compared between groups.


RESULTS
Of the 321 PCNLs, 60 (18.7%) occurred in patients chronically taking aspirin. The on-aspirin group included 17 PCNLs (5.2%), while the off-aspirin group included 43 PCNLs (13.4%). There were no differences between groups in terms of operative time (77 minutes vs 74 minutes, p=0.212), hemoglobin change (p=0.522), stone size (21 mm vs 22 mm, p=1.0), stone-free rate (p=0.314), median length of hospitalization (p=0.642), transfusion rate (p=0.703), or total complications (p=1.0). No patient experienced a thromboembolic event.


CONCLUSIONS
PCNL is safe in patients continuing aspirin perioperatively and does not result in more blood transfusions, angioembolization procedures, or complications. Patients with large stone burdens who are at high risk for thromboembolic events appear to be able to safely undergo PCNL without discontinuing aspirin.
The Smith Institute for Urology , Hofstra North Shore Long Island Jewish School of Medicine, New Hyde Park, New York.
David A
DA
Leavitt
Nithin
N
Theckumparampil
Daniel M
DM
Moreira
Sammy E
SE
Elsamra
Nikhil
N
Waingankar
David M
DM
Hoenig
Arthur D
AD
Smith
Zeph
Z
Okeke
D000368:Aged; D001241:Aspirin / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D061646:Operative Time; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011300:Preoperative Care; D012189:Retrospective Studies
D010975:Platelet Aggregation Inhibitors; D001241:Aspirin