PCNL Safe Despite Chronic Anti-Clotting Drug Use
Percutaneous nephrolithotomy (PCNL) is safe to perform in patients on chronic anticoagulant or antiplatelet therapy, according to a study.
Researchers at KLES Dr. Prabhakar Kore Hospital & Medical Research Centre in Belgaum, India, studied 36 urolithiasis patients (30 men and six women; mean age of 46 years) who were on chronic anticoagulant or antiplatelet therapy and underwent PCNL for renal stones (mean stone size 6.4 cm2). Twenty-one patients were on warfarin and 15 were on clopidogrel.
Bleeding was successfully managed in all patients and anticoagulant/antiplatelet therapy resumed after an appropriate duration, the investigators reported in the Chonnam Medical Journal (2012;48:103-107). The mean blood loss was 380 mL for the first 15 patients and 252 mL for the 21 subsequent cases. No intraoperative complications occurred and no patient required an intraoperative blood transfusion. No patient was readmitted for secondary bleeding. At three months, the stone-free rate was 100%.
In patients on warfarin, the drug was withheld for at least five days before surgery and resumed after five days postoperatively. These patients were given vitamin K daily for three days. Heparin was used to bridge the interim period. Patients on clopidogrel had the medication stopped for 10 days preoperatively and restarted at least five days after surgery. The mean operating time was 62 minutes.
Based on their study, they made the following surgical recommendations: use balloon dilatation for tracts, use smaller operating nephroscopes, preferably use a single tract, and keep the operating time to a bare minimum.