Transient cessation of antiplatelet medication before percutaneous stone surgery: does it have any safety concern on bleeding related problems?
To evaluate the short term effects of transient AP medication cessation on the safety of percutaneous nephrolithotomy (PCNL) and evaluate them with normal cases in a comparative manner. 71 cases undergoing PCNL for renal pelvic stones were divided into two groups: Group 1 (n: 35) Cases under AP medication (100 mg/day acetyl salicylic acid) in whom the medication was stopped for 7 days before PCNL procedure. Group 2 (n: 36) Cases without any AP medication prior to PCNL. Coagulation test parameters were normal in all cases prior to stone removal. Treatment related parameters with an emphasis on post-operative course were evaluated between two groups. While prolonged macroscopic hematuria (mean 3.5 days) was present in a 25.7 % of the cases in Group 1; it was 5.7 % in Group 2 (mean 2 days). Mean duration of nephrostomy tube was longer in Group 1 (3.49 vs 2.64 days respectively). Additionally, hospitalization period was longer in cases under antiplatelet therapy when compared with the others. No statistically significant difference was noted between two groups regarding post-operative Hb drop rates, transfusion, fever, embolization rates. Lastly, of all the risk factors evaluated; use of AP medication was found to increase the risk of macroscopic hematuria 5.8-fold on logistic regression analysis. Our findings demonstrated that despite the cessation of the antiplatelet agents with an appropriate regimen; these cases should be followed for the risk of prolonged hematuria and tube drainage after PCNL in a very close manner.
Department of Urology, Dr. Lutfi KIRDAR Research and Training Hospital, Istanbul, Turkey. cahitsahin129@gmail.com.|, Gömeç sok. Sabancı -2 Sitesi A1 Kat 4 Daire 24 Acıbadem-Kadıköy, Istanbul, Turkey. cahitsahin129@gmail.com.
Cahit
C
Sahin
Department of Urology, Dr. Lutfi KIRDAR Research and Training Hospital, Istanbul, Turkey.
Utku
U
Can
Department of Urology, Dr. Lutfi KIRDAR Research and Training Hospital, Istanbul, Turkey.
Bilal
B
Eryildirim
Department of Urology, Dr. Lutfi KIRDAR Research and Training Hospital, Istanbul, Turkey.
Kemal
K
Sarica
D000328:Adult; D000368:Aged; D001780:Blood Coagulation Tests; D001803:Blood Transfusion / Q000706:statistics & numerical data; D004621:Embolization, Therapeutic; D005260:Female; D006417:Hematuria / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy / Q000652:urine; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007669:Kidney Calculi / Q000097:blood / Q000601:surgery* / Q000652:urine; D007682:Kidney Pelvis / Q000473:pathology / Q000601:surgery; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D000074642:Nephrolithotomy, Percutaneous / Q000009:adverse effects*; D009403:Nephrostomy, Percutaneous / Q000706:statistics & numerical data; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000097:blood / Q000453:epidemiology* / Q000628:therapy / Q000652:urine; D012307:Risk Factors; D013923:Thromboembolism / Q000517:prevention & control; D013997:Time Factors; D028761:Withholding Treatment
D006454:Hemoglobins; D010975:Platelet Aggregation Inhibitors
Antiplatelet medication; Hematuria; Kidney stones; Percutaneous nephrolithotomy
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