Continuous Perioperative use of Aspirin as Single Therapy during Percutaneous Nephrolithotomy

Abstract

Introduction: The rates of heart disease and nephrolithiasis continue to increase in the United States, and aspirin is increasingly prescribed for varying indications. Current recommendations in the urologic literature are to stop aspirin before percutaneous nephrolithotomy (PCNL); however, this is based on expert opinion. This study aims to determine the safety of PCNL performed on patients who took aspirin in the perioperative period. Methods: This study was a retrospective review of 27 consecutive PCNLs for patients who took aspirin in the perioperative period (January 2013-September 2016). Pre- and postoperative hemoglobin was recorded, as were age, sex, BMI, operative duration, skin-to-stone distance, stone size, aspirin dose, aspirin indication, number of blood transfusions, and Clavien-Dindo complication classification. Correlations between hemoglobin and explanatory variables were then explored with linear regression and the Wilcoxon rank-sum test. Results: Of the 199 PCNLs performed, 27 procedures on 23 patients were conducted without discontinuing aspirin perioperatively. Coronary artery disease was the most common indication for aspirin use (81%). Patients experienced a median hemoglobin decline of 1.4 g/dl perioperatively. No significant associations were found between hemoglobin decline and age, sex, BMI, operative duration, skin-to-stone distance, or stone size. There were no Clavien-Dindo grade III or higher complications, and no patients required a blood transfusion or angio-embolization. There were no thrombo-embolic or cardiac events in our series. Conclusions: In our single-center experience, PCNLs performed on patients taking aspirin perioperatively were not associated with the need for blood transfusion nor the occurrence of high-grade complications.