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经皮肾镜取石术在慢性抗凝或抗血小板治疗患者中的安全性。

Safety of percutaneous nephrolithotomy in patients on chronic anticoagulant or antiplatelet therapy.

机构信息

Department of Urology, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain.

出版信息

Urolithiasis. 2018 Nov;46(6):581-585. doi: 10.1007/s00240-018-1034-1. Epub 2018 Jan 22.

Abstract

In developed countries, the incidence of cardiovascular disease is increasing, therefore, anticoagulant and antiplatelet drugs are a widespread treatment nowadays. Percutaneous nephrolithotomy (PNL) is the first-line treatment for large or complex stones (> 2 cm) and remains an alternative for the smaller ones. The objective of this study is to analyze whether PNL surgery is a safe procedure in patients under a treatment discontinuation protocol for anticoagulant or antiplatelet therapies. We retrospectively studied 301 patients who underwent PNL in our hospital between 2008 and 2016 and identified 46 patients on chronic antiplatelet or anticoagulation treatment. With respect to PNL outcomes, the stone-free rate was similar (78 vs 74%, p = 0.762) in both groups, without any significant differences in the overall postoperative complications (17 vs 26%, p = 0.203). The incidence of hemorrhagic complications was similar between groups (12 vs 9%, p = 0.492), as demonstrated by the mean drop in hemoglobin (Hb), which was comparable in both cohorts (2.2 ± 1.3 vs 2.0 ± 1.4 p = 0.270) and the blood transfusion rate (14% in group A and 8% in group B, p = 0.205). No thromboembolic events were found within the year after the PNL procedure. PNL is a safe and effective intervention in patients under a treatment discontinuation protocol for anticoagulant or antiplatelet therapies. Although our study demonstrates the feasibility of this protocol, new scientific evidence aims to stratify the thromboembolic and bleeding risk of each patient to individualize the perioperative management thereafter.

摘要

在发达国家,心血管疾病的发病率正在上升,因此,抗凝和抗血小板药物是目前广泛使用的治疗方法。经皮肾镜碎石术(PNL)是治疗大或复杂结石(>2cm)的首选方法,也是治疗较小结石的替代方法。本研究旨在分析在抗凝或抗血小板治疗停药方案下的患者中,PNL 手术是否安全。我们回顾性研究了 2008 年至 2016 年间在我院接受 PNL 的 301 例患者,确定了 46 例接受慢性抗血小板或抗凝治疗的患者。就 PNL 结果而言,两组的结石清除率相似(78%比 74%,p=0.762),总体术后并发症无显著差异(17%比 26%,p=0.203)。两组出血性并发症的发生率相似(12%比 9%,p=0.492),两组血红蛋白(Hb)平均下降量相似(2.2±1.3 比 2.0±1.4,p=0.270),输血率相似(A 组 14%,B 组 8%,p=0.205)。在 PNL 术后 1 年内未发现血栓栓塞事件。在抗凝或抗血小板治疗停药方案下的患者中,PNL 是一种安全有效的干预措施。尽管我们的研究证明了该方案的可行性,但新的科学证据旨在对每个患者的血栓栓塞和出血风险进行分层,以便此后对围手术期管理进行个体化。

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