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. 2012 Aug;48(2):103-7.
doi: 10.4068/cmj.2012.48.2.103. Epub 2012 Aug 24.

Percutaneous nephrolithotomy in patients on chronic anticoagulant/antiplatelet therapy

R B Nerli  1 , M N Reddy, S Devaraju, M B Hiremath
Affiliations

Percutaneous nephrolithotomy in patients on chronic anticoagulant/antiplatelet therapy

R B Nerli et al. Chonnam Med J. 2012 Aug.

Abstract

Percutaneous nephrolithotomy (PCNL) is an integral component in the management of large volume renal stone disease either as monotherapy or in combination with shock wave lithotripsy. Stone disease in patients on chronic anticoagulation/antiplatelet therapy, however, poses a difficult scenario. Bleeding is a major concern for any patient undergoing PCNL. We retrospectively analyzed our series of patients with renal calculi who were on chronic anticoagulant therapy and who underwent PCNL. We reviewed the case records of patients undergoing PCNL during the period from January 2005 to December 2011. We analyzed the changes in preoperative and postoperative hemoglobin, serum creatinine, and clotting parameters, as well as intraoperative and postoperative bleeding and thromboembolic complications. During the 5-year study period, a total of 36 patients (30 males and 6 females) with a mean age of 46.33±9.96 years (range, 29-61 years) who were on chronic anticoagulant/antiplatelet therapy underwent PCNL for urolithiasis. The mean size of the stone was 6.40±1.98 cm(2) (range, 2.8-9 cm(2)). The mean operating time was 62.08±10.10 min. The bleeding was successfully managed in all patients and the anticoagulant/antiplatelet agents were restarted after an appropriate duration. The mean rise in serum creatinine at discharge was 0.05±0.03 mg/dl and the mean fall in serum hemoglobin was 1.63±0.77 g/dl. At 3 months after surgery, the stone-free rate was 100%. With careful preoperative care and regulation of anticoagulation/antiplatelet therapy and appropriate intraoperative management, PCNL can be performed safely and successfully in properly selected patients with renal calculi who are on chronic anticoagulant/antiplatelet therapy.

Keywords: Anticoagulants; Antiplatelet agents; Kidney calculi; Percutaneous nephrolithotomy; Urolithiasis.

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Figures

FIG. 1
FIG. 1
Pre operative coronal CT view of patient with left renal calculus and right gross hydronephrosis due to congenital UPJ obstruction.
FIG. 2
FIG. 2
Post operative coronal CT view of same patient as in Fig. 1 with complete stone clearance and DJ stent in situ.
FIG. 3
FIG. 3
Guidelines for the perioperative management of anticoagulation.
See this image and copyright information in PMC

References

    1. Preminger GM, Assimos DG, Lingeman JE, Nakada SY, Pearle MS, Wolf JS, Jr AUA Nephrolithiasis Guideline Panel. Chapter 1: AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations. J Urol. 2005;173:1991–2000. - PubMed
    1. Klingler HC, Kramer G, Lodde M, Dorfinger K, Hofbauer J, Marberger M. Stone treatment and coagulopathy. Eur Urol. 2003;43:75–79. - PubMed
    1. Lee WJ, Smith AD, Cubelli V, Badlani GH, Lewin B, Vernace F, et al. Complications of percutaneous nephrolithotomy. AJR Am J Roentgenol. 1987;148:177–180. - PubMed
    1. Giusti G, Piccinelli A, Taverna G, Benetti A, Pasini L, Corinti M, et al. Miniperc? No, thank you! Eur Urol. 2007;51:810–814. - PubMed
    1. Netto NR, Jr, Ikonomidis J, Ikari O, Claro JA. Comparative study of percutaneous access for staghorn calculi. Urology. 2005;65:659–662. - PubMed