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Percutaneous nephrolithotomy appears safe, effective in patients on continued low-dose aspirin

28 Feb 2018

It appears that percutaneous nephrolithotomy is safe and effective in patients maintaining low-dose aspirin treatment perioperatively, according to a recent study.

Low-dose aspirin was maintained in 67 patients (24.5 percent), while 207 (75.5 percent) were not on aspirin. Those in the aspirin group were older (66 vs 52 years), included more tobacco users (58.2 percent vs 31.4 percent) and had a higher ASA (American Society of Anesthesiologists) score (2.9 vs 2.5; p<0.001 for all).

No between-group difference was observed in mean STONE (size, topography [stone location], obstruction, number of stones and evaluation of Hounsfield Units) score (7.6 vs 7.7; p=0.71) or blood loss (44 vs 54 ml; p=0.151). There was also no difference in residual stone fragment size, including 0–2 mm in 65.3 percent vs 61.4 percent of aspirin vs no aspirin patients, 3–4 mm in 19.4 percent vs 16.2 percent, and >4 mm in 15.3 percent vs 22.4 percent (p=0.407), respectively.

Length of stay and the change in haemoglobin, haematocrit and creatinine were comparable between the two groups. Readmission rate (14.9 percent vs 12.6 percent; p=0.618) or the total complication rate (34.4 percent vs 26.6 percent; p=0.221) was also similar. Moreover, no difference was seen in the number of major complications (10.4 percent vs 5.8 percent; p=0.193), bleeding complications (3.0 percent vs 2.9 percent; p=0.971) and the transfusion rate (1.5 percent vs 1.0 percent; p=0.57).

“Aspirin is often stopped prior to percutaneous nephrolithotomy due to concern about the surgical bleeding risk,” the authors said. “There is evidence that discontinuing aspirin perioperatively increases thromboembolic events and continuing it may be safe.”

To examine the effect of continuing low-dose aspirin through percutaneous nephrolithotomy and its effect on surgical and safety outcomes, the authors retrospectively reviewed the records of 285 consecutive percutaneous nephrolithotomies conducted between 2012 and 2015. Outcomes and complications were compared in patients who continued 81-mg aspirin daily to those in patients not receiving aspirin.

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