title: The Effect of Anticoagulation on Bleeding-related Complications Following Ureteroscopy.
abstract: OBJECTIVE
  To analyze bleeding-related complications among patients on long-term anticoagulation (AC) undergoing ureteroscopy (URS). Current American Urological Association/International Consultation on Urological Diseases guidelines state that it is safe to continue AC in routine URS; however, these recommendations are based on small case series.
  
  
  METHODS
  There were 4799 identified URS procedures performed at our institution between June 2009 and February 2016. Records were then retrospectively reviewed to confirm AC use and identify periprocedural complications. Anticoagulant agents evaluated included warfarin, enoxaparin, and non-vitamin K antagonists (ie, rivaroxaban, dabigatran, apibaxan). Patients were excluded if they were taking a concurrent antiplatelet (AP) agent or if additional non-URS procedures were performed.
  
  
  RESULTS
  Of the 4799 URS procedures, 272 (5.6%) were done on patients taking chronic AC. Of these, 193 (71%) held AC, 53 (19%) were bridged with enoxaparin, and 26 (10%) continued AC. The median age was 70.2 years and the majority of patients (64.2%) underwent a stone procedure with a stone-free rate of 73%. The overall bleeding-related complication rate was 8.1% whereas the significant bleeding-related event rate was 5.9%. Patients continuing AC had the highest significant bleeding-related event rate at 15.4% compared to 9% and 3% for those bridged with enoxaparin and those who held, respectively (P = .01).
  
  
  CONCLUSIONS
  Continuation or bridging of AC may increase the risk of perioperative bleeding. The risks and benefits of proceeding with URS on AC must be weighed carefully. Pending external validation, this information may be used for patient counseling and risk stratification.
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Westerman
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Scales
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN.
authors.forename: Vidit
authors.initials: V
authors.lastname: Sharma
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Gearman
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN; Maine Medical Center, South Portland, ME.
authors.forename: Johann P
authors.initials: JP
authors.lastname: Ingimarsson
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN; IU Health Physicians, Indianapolis, IN. Electronic address: gecoots2@gmail.com.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Krambeck
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D004334:Drug Administration Schedule; D017984:Enoxaparin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000453:epidemiology*; D012189:Retrospective Studies; D014515:Ureteral Diseases / Q000601:surgery*; D018666:Ureteroscopy / Q000009:adverse effects*; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D014859:Warfarin