Antiplatelet and anticoagulative medication during shockwave lithotripsy.

Abstract

Shockwave lithotripsy (SWL) is the gold standard treatment of patients with most renal and proximal ureteral calculi. Severe bleeding complications in SWL are extremely rare. Uncorrected bleeding diathesis might increase the risk and is considered to be an absolute contraindication for SWL. Perioperative management of anticoagulative and antiplatelet therapy has changed in the recent past. In particular, low-dose acetylsalicylic acid (ASA) is no longer a contraindication for many surgical procedures. A systematic Medline/PubMed literature search of peer-reviewed scientific articles in urology and cardiovascular medicine was performed concerning the management of anticoagulative and antiplatelet medication during SWL. The literature on medically acquired and pathological bleeding diathesis and SWL in general is rare, retrospective, nonstandardized, and of low quality. Routine cessation of obligatory indicated anticoagulative or antiplatelet medication implies a significant risk for cardiovascular adverse events (CAE). Ureterorenoscopy is recommended in patients with uncorrected bleeding diathesis, although this is not based on high-level evidence. In patients with obligatory intake of anticoagulative or antiplatelet medication, the risk for CAE must be balanced against the SWL-induced bleeding risk. In patients with low-dose ASA-intake, SWL should be considered as an option instead of being disregarded as an absolute contraindication. Prospective randomized trials designed to define the optimal management of anticoagulants and antiplatelets during SWL are warranted.