The effects of continuing aspirin on blood loss and postoperative outcomes in percutaneous nephrolithotomy.

IF 1.5 Q3 UROLOGY & NEPHROLOGY American journal of clinical and experimental urology Pub Date : 2023-01-01
Emma Rosenbluth, Christine W Liaw, Jacob N Bamberger, Aisosa Omorogbe, Johnathan A Khusid, Raymond Khargi, Alan J Yaghoubian, Anna Ricapito, Blair Gallante, William M Atallah, Mantu Gupta
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Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

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持续服用阿司匹林对经皮肾镜取石术出血量及术后预后的影响。
背景:经皮肾镜取石术(PCNL)是一种治疗复杂肾结石但有出血风险的有效手术。目前尚不清楚阿司匹林是否应该在PCNL之前停用。我们的目的是进一步证实PCNL手术期间持续服用阿司匹林的安全性,并确定阿司匹林状态是否会影响PCNL术后的预后。方法:我们回顾性查询了2017年10月至2022年12月在我们的大容量三级转诊中心接受PCNL的患者的泌尿系统数据库。三组基于PCNL时的阿司匹林状态:不服用阿司匹林(NA),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、输血和并发症。结果:共有648例患者被分为以下研究组:NA患者525例(81.0%),DA患者55例(8.5%),CA患者68例(10.5%)。DA组和CA组的合并症相似,两者在基线时的合并症均高于NA组。术后实验室值变化及并发症无显著差异。CA组和DA组术后输血率高于NA组,且接近统计学意义。单独的DA组和CA组之间的任何术后结果均无显著差异。结论:在接受慢性阿司匹林治疗的患者中,在PCNL前继续服用阿司匹林与停止服用阿司匹林同样安全。大多数患者不应该因为理论上的出血风险而放弃持续服用阿司匹林的好处。长期服用阿司匹林的患者比不服用阿司匹林的患者更有可能需要输血。然而,不管是否停止使用阿司匹林,这可能是由患者合并症而不是失血率升高引起的。
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