Chonnam Med J.  2012 Aug;48(2):103-107. 10.4068/cmj.2012.48.2.103.

Percutaneous Nephrolithotomy in Patients on Chronic Anticoagulant/Antiplatelet Therapy

• Nerli RB
• Reddy MN
• Devaraju S
• Hiremath M

• KMID: 2172211
• DOI: http://doi.org/10.4068/cmj.2012.48.2.103

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 cm2 (range, 2.8-9 cm2). 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.

Keyword

Urolithiasis; Percutaneous nephrolithotomy; Anticoagulants; Antiplatelet agents; Kidney calculi

MeSH Terms

Anticoagulants
Creatinine
Hemoglobins
Hemorrhage
Humans
Kidney Calculi
Lithotripsy
Male
Nephrostomy, Percutaneous
Platelet Aggregation Inhibitors
Preoperative Care
Retrospective Studies
Shock
Urolithiasis
Anticoagulants
Creatinine
Hemoglobins
Platelet Aggregation Inhibitors

Figure

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  FIG. 1 Pre operative coronal CT view of patient with left renal calculus and right gross hydronephrosis due to congenital UPJ obstruction.

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  FIG. 2 Post operative coronal CT view of same patient as in Fig. 1 with complete stone clearance and DJ stent in situ.

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  FIG. 3 Guidelines for the perioperative management of anticoagulation.

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