Rosenbluth Emma, Liaw Christine W, Bamberger Jacob N, Omorogbe Aisosa, Khusid Johnathan A, Khargi Raymond, Yaghoubian Alan J, Ricapito Anna, Gallante Blair, Atallah William M, Gupta Mantu
Department of Urology, Icahn School of Medicine 1 Gustave L. Levy Place, New York, NY 10029, US.
Am J Clin Exp Urol. 2023 Feb 25;11(1):50-58. eCollection 2023.
Percutaneous nephrolithotomy (PCNL) is an effective surgery for complex kidney stones yet with inherent bleeding risks. It remains unclear whether aspirin should be discontinued prior to PCNL. We aimed to further substantiate the safety of continuing aspirin during PCNL surgery and to determine whether aspirin status affects postoperative outcomes following PCNL.
We retrospectively queried our endourology database for patients who underwent PCNL from October 2017 to December 2022 at our high-volume tertiary referral center. The three groups were based on aspirin status at the time of PCNL: no aspirin (NA), discontinued aspirin (DA), and continued aspirin (CA). Data collected included demographics, preoperative characteristics, operative parameters, pre and postoperative lab values, transfusions, and complications.
A total 648 patients were divided into these study groups: 525 NA patients (81.0%), 55 DA (8.5%), and 68 CA (10.5%). The DA and CA groups were of similar comorbidities, and both were more comorbid at baseline than NA. Postoperative change in lab values and complications did not differ significantly. Rates of postoperative blood transfusion were higher in the CA and DA groups compared to NA and approached statistical significance. There were no significant differences in any postoperative outcomes between the DA and CA groups alone.
In patients on chronic aspirin therapy, continuing aspirin appears equally safe to discontinuing aspirin prior to PCNL. Most patients should not forego the benefits of continuous aspirin for the theoretical risk of bleeding. Patients on prolonged aspirin therapy may be more likely than those who are not on chronic aspirin therapy to require blood transfusions. However, regardless of whether aspirin use is stopped, this may be caused by patient comorbidities rather than higher rates of blood loss.
经皮肾镜取石术（PCNL）是治疗复杂性肾结石的有效手术，但存在内在出血风险。PCNL术前是否应停用阿司匹林仍不明确。我们旨在进一步证实PCNL手术期间继续使用阿司匹林的安全性，并确定阿司匹林状态是否会影响PCNL术后的结果。
我们回顾性查询了我们的泌尿外科数据库，以获取2017年10月至2022年12月在我们这个高容量三级转诊中心接受PCNL的患者。这三组基于PCNL时的阿司匹林状态：未服用阿司匹林（NA）、已停用阿司匹林（DA）和继续服用阿司匹林（CA）。收集的数据包括人口统计学、术前特征、手术参数、术前和术后实验室值、输血情况和并发症。
总共648例患者被分为这些研究组：525例NA患者（81.0%）、55例DA患者（8.5%）和68例CA患者（10.5%）。DA组和CA组的合并症相似，且两者在基线时的合并症都比NA组更多。术后实验室值变化和并发症无显著差异。CA组和DA组的术后输血率高于NA组，接近统计学意义。单独的DA组和CA组之间的任何术后结果均无显著差异。
对于长期服用阿司匹林治疗的患者，继续服用阿司匹林在PCNL术前似乎与停用阿司匹林同样安全。大多数患者不应因理论上的出血风险而放弃持续服用阿司匹林的益处。长期服用阿司匹林治疗的患者可能比未长期服用阿司匹林治疗的患者更有可能需要输血。然而，无论是否停用阿司匹林，这可能是由患者的合并症引起的，而不是失血率更高。
