Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH.
Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH.
Urology. 2024 Jan;183:32-38. doi: 10.1016/j.urology.2023.09.022. Epub 2023 Sep 30.
To evaluate peri-operative outcomes in patients on chronic aspirin therapy undergoing percutaneous nephrolithotomy (PCNL), with and without discontinuation of aspirin. Anti-coagulation and anti-platelet therapy are contraindications for PCNL per American Urological Association guidelines due to bleeding risk. However, there is potentially increased cardiovascular risk with peri-procedural aspirin withdrawal.
Patients on chronic aspirin undergoing PCNL between January 2014 and May 2019 were retrospectively reviewed and stratified by continued or discontinued aspirin >5 days preoperatively. Hematologic complications, transfusions, and thrombotic complications were assessed with logistic regression model.
Three hundred twenty-five patients on chronic aspirin therapy underwent PCNL-85 continued and 240 discontinued aspirin. There were no significant differences in hemoglobin change, estimated blood loss, transfusions, creatinine change, thrombotic complications, 30-days re-admissions, complications, or 30-day emergency department visits. Patients who continued aspirin had longer length of stay (1.6 vs 1.9 days, P = .03). American Society of Anesthesiologists (ASA) score of 3 (OR 3.2, P = .02, 95% confidence intervals (CI) [1.2-8.4]), ASA score of 4 (OR 4.0, P = .02, 95% CI [1.2-13.1]), Black race, and previous smoking (OR 2.1, P = .02, 95% CI [1.1-3.9]) was associated with continued aspirin. Body mass index ≥30 was associated with aspirin discontinuation (OR 0.9, P = .004, 95% CI [0.9-1.0]). Increased postoperative hematologic complications were associated with additional anticoagulation medication (OR 2.9, P = .04, 95% CI [1.0-4.4]).
Continued aspirin use did not increase in postoperative complications in patients undergoing PCNL. Patients who are on additional anticoagulation medication are at risk of hematologic complications.
评估接受经皮肾镜碎石术（PCNL）的慢性阿司匹林治疗患者的围手术期结局，包括继续或停止阿司匹林治疗的患者。由于出血风险，美国泌尿外科学会指南规定，抗凝和抗血小板治疗是 PCNL 的禁忌证。然而，停止围手术期阿司匹林治疗可能会增加心血管风险。
回顾性分析 2014 年 1 月至 2019 年 5 月期间接受慢性阿司匹林治疗并接受 PCNL 的患者，并根据术前 5 天以上是否继续或停止阿司匹林治疗进行分层。采用 logistic 回归模型评估血液学并发症、输血和血栓并发症。
325 例接受慢性阿司匹林治疗的患者接受了 PCNL-85 例继续和 240 例停止阿司匹林治疗。血红蛋白变化、估计失血量、输血、肌酐变化、血栓并发症、30 天再入院率、并发症或 30 天急诊就诊率无显著差异。继续服用阿司匹林的患者住院时间更长（1.6 天 vs 1.9 天，P=0.03）。美国麻醉医师协会（ASA）评分 3 分（OR 3.2，P=0.02，95%置信区间（CI）[1.2-8.4]）、ASA 评分 4 分（OR 4.0，P=0.02，95% CI [1.2-13.1]）、黑种人、和以前吸烟（OR 2.1，P=0.02，95% CI [1.1-3.9]）与继续服用阿司匹林有关。体质指数≥30 与阿司匹林停药有关（OR 0.9，P=0.004，95% CI [0.9-1.0]）。术后血液学并发症增加与额外抗凝药物有关（OR 2.9，P=0.04，95% CI [1.0-4.4]）。
在接受 PCNL 的患者中，继续使用阿司匹林不会增加术后并发症。服用额外抗凝药物的患者有发生血液学并发症的风险。
