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WCE 2017: Perioperative Aspirin Use During Percutaneous Nephrolithotomy (PCNL): Our Single Center Experience

Vancouver, Canada (UroToday.com) Dr. Michael Sourial, endourological fellow at The Ohio State University Wexner Medical Center, presented his findings on the feasibility and risk analysis of perioperative aspirin use during percutaneous nephrolithotomy (PCNL) for patients who are at high risk of heart disease. In the past, urologists have been wary of using PCNL on patients who are taking aspirin due to the reduction of red blood cells and hemoglobin levels, so they opt for ureteroscopy instead, which is a much less effective treatment for large renal stones. Dr. Sourial and his team attempted to determine whether this fear is justified. 

The study consisted of a retrospective study of 199 PCNLs performed at the Wexner Medical Center by a single surgeon in Ohio between January 2013 and September 2016. Of the 199 PCNLs reviewed, only 27 procedures did not discontinue the patient taking aspirin preoperatively. 24 of these cases had patients taking 81 mg of daily aspirin while the remaining three were patients taking 325 mg daily.  

Through their research, it was determined that the average hemoglobin drop for these cases was 1.3 g/dl, while the largest recorded drop was 4.1 g/dl. Dr. Sourial stated, however, that there were no significant associations between the hemoglobin decline and operative duration, skin-to-tone distance, or stone size. Furthermore, no patients required blood transfusions or any special care due to complications during the perioperative period. 

In closing, Dr. Sourial explained that in this center’s experience, PCNLs performed on patients taking daily aspirin for heart disease were not associated with any adverse complications or emergency treatment. Dr. Sourial also mentioned that this research must be continued in a multi-institutional, prospective study before it can be universally accepted, but he was hopeful that their findings would be put into practice. Furthermore, he warned the audience about “aspirin withdrawal syndrome” which could occur after discontinuing daily doses of aspirin from the patient, causing an unsafe rebound effect resulting in a temporary loss of platelet reactivity. 

Presented by: Michael Sourial 

Authors: Joshua J. Ebel and Bodo Knudsen
Affiliation: The Ohio State University Department of Urology 

Written by: Zachary Valley, Department of Urology, University of California-Irvine at the 35th World Congress of Endourology– September 12-16, 2017, Vancouver, Canada.