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Background:
Percutaneous nephrolithotomy (PCNL) is a preferred treatment for larger renal stones, although not typically performed on anticoagulated patients. For those undergoing PCNL who require perioperative anticoagulation, the incidence of bleeding complications remains undefined.
Methods:
Charts of consecutive patients who underwent PCNL at 2 tertiary centers were reviewed. Patient demographics , anticoagulant regimen (agent, time held pre- and post-op), and occurrence of bleeding complications (defined as requiring transfusion or angiography for severe bleeding, pseudoaneurysm, or arterovenous fistula) were collected.
Results:
261 patients underwent PCNL. Of those, 225 did not receive therapeutic anticoagulation and 36 did receive aspirin, clopidogrel, heparin, enoxaparin, or warfarin perioperatively. Of those anticoagulated, 2 (5.5%) continued through the procedure, 9 (25%) restarted anticoagulation within 24 hours, 11 (30.5%) at 48 hours, 3 (8.3%) at 72 hours, and 11 (30.5%) at 72 hours or greater. Overall, bleeding complications occurred in 6 of the 261 patients (2.3%). Specifically, bleeding complications arose in 3 of the 225 (1.3%) not anticoagulated compared with 3 of the 36 (8.3%) receiving anticoagulation (Fisher's exact test, p 0.04). One of 2 (50%) who continued aspirin through the procedure and 2 of 3 (67%) who received therapeutic heparin on postoperative day 1 had bleeding complications. In all others, anti-coagulation medications were resumed on postoperative day #2 or later without identified bleeding complication.
Conclusion:
There is a statistically significant increase in the incidence of bleeding complications for patients receiving anticoagulant therapy in the perioperative period. The highest risk for bleeding complication occurred in patients receiving therapeutic anticoagulation within the first 24 postoperative hours.