EAU 2019: Anticoagulation and Stone Treatment - What is Possible?

Barcelona, Spain (UroToday.com) Speaking of the relevance of the problem of anticoagulation/antiplatelet therapy Dr. Ghani mentioned that approximately 10% of the patients on oral AC/AP medications will require an invasive procedure each year. This is confirmed by the fact that in 2015 worldwide sales of Rivaroxaban were 4.3 billion dollars. In this presentation, Dr. Ghani tried to find out if ureteroscopy is a primary modality treatment for stones in this group of patients.

Based on the international data and AUA/EUA guidelines Dr. Ghani said that anticoagulation/antiplatelet therapy is a contraindication for ESWL and PCNL. These patients need to discontinue AC/AP therapy for getting ESWL/PCNL options which could potentially lead to 10-46% of mortality.

Clinicians should use URS as first-line therapy in most patients who require stone intervention in the setting of uncorrected bleeding diatheses or who require continuous AC/AP therapy. Also, Dr. Ghani mentioned that it is useful to have a database like MUSIC which he tries to create to understand best practices and designing interventions to improve the quality of stone surgery. 

Finally, the author came to the following conclusions: URS is the only treatment modality where stone surgery can be performed without stopping AC or AP agents. However, URS studies demonstrate a higher risk of hospitalization and bleeding in these patients. Nevertheless, the trend for increasing URS will continue for the foreseeable future, particularly for those who must remain anticoagulated meaning they cannot receive PCNL or SWL.


Presented by: Khurshid Ridwan Ghani, MD, MS, FRCS, Assistant Professor, Minimally Invasive Surgery, Stone Disease, University of Michigan, Ann Arbor, Michigan, United States

Written by: Dmitry Korolev, Sechenov First Moscow State Medical University, Institute of Uronephrology and Human Reproductive Health, Moscow, Russia, at the 34th European Association of Urology (EAU 2019) #EAU19 conference in Barcelona, Spain, March 15-19, 2019.