The Effect of Anticoagulation on Bleeding-related Complications Following Ureteroscopy.
Urology
; 100: 45-52, 2017 Feb.
Article
en En
| MEDLINE
| ID: mdl-27720775
ABSTRACT
OBJECTIVE:
To analyze bleeding-related complications among patients on long-term anticoagulation (AC) undergoing ureteroscopy (URS). Current American Urological Association/International Consultation on Urological Diseases guidelines state that it is safe to continue AC in routine URS; however, these recommendations are based on small case series. PATIENTS ANDMETHODS:
There were 4799 identified URS procedures performed at our institution between June 2009 and February 2016. Records were then retrospectively reviewed to confirm AC use and identify periprocedural complications. Anticoagulant agents evaluated included warfarin, enoxaparin, and non-vitamin K antagonists (ie, rivaroxaban, dabigatran, apibaxan). Patients were excluded if they were taking a concurrent antiplatelet (AP) agent or if additional non-URS procedures were performed.RESULTS:
Of the 4799 URS procedures, 272 (5.6%) were done on patients taking chronic AC. Of these, 193 (71%) held AC, 53 (19%) were bridged with enoxaparin, and 26 (10%) continued AC. The median age was 70.2 years and the majority of patients (64.2%) underwent a stone procedure with a stone-free rate of 73%. The overall bleeding-related complication rate was 8.1% whereas the significant bleeding-related event rate was 5.9%. Patients continuing AC had the highest significant bleeding-related event rate at 15.4% compared to 9% and 3% for those bridged with enoxaparin and those who held, respectively (P = .01).CONCLUSION:
Continuation or bridging of AC may increase the risk of perioperative bleeding. The risks and benefits of proceeding with URS on AC must be weighed carefully. Pending external validation, this information may be used for patient counseling and risk stratification.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Enfermedades Ureterales
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Pérdida de Sangre Quirúrgica
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Ureteroscopía
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Hemorragia Posoperatoria
/
Anticoagulantes
Tipo de estudio:
Observational_studies
/
Risk_factors_studies
Límite:
Aged
/
Female
/
Humans
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Male
/
Middle aged
Idioma:
En
Revista:
Urology
Año:
2017
Tipo del documento:
Article
País de afiliación:
Mongolia