PMID- 27720775
OWN - NLM
STAT- MEDLINE
DCOM- 20180308
LR  - 20180308
IS  - 1527-9995 (Electronic)
IS  - 0090-4295 (Linking)
VI  - 100
DP  - 2017 Feb
TI  - The Effect of Anticoagulation on Bleeding-related Complications Following 
      Ureteroscopy.
PG  - 45-52
LID - S0090-4295(16)30653-7 [pii]
LID - 10.1016/j.urology.2016.09.034 [doi]
AB  - OBJECTIVE: To analyze bleeding-related complications among patients on long-term 
      anticoagulation (AC) undergoing ureteroscopy (URS). Current American Urological 
      Association/International Consultation on Urological Diseases guidelines state 
      that it is safe to continue AC in routine URS; however, these recommendations are 
      based on small case series. PATIENTS AND METHODS: There were 4799 identified URS 
      procedures performed at our institution between June 2009 and February 2016. 
      Records were then retrospectively reviewed to confirm AC use and identify 
      periprocedural complications. Anticoagulant agents evaluated included warfarin, 
      enoxaparin, and non-vitamin K antagonists (ie, rivaroxaban, dabigatran, 
      apibaxan). Patients were excluded if they were taking a concurrent antiplatelet 
      (AP) agent or if additional non-URS procedures were performed. RESULTS: Of the 
      4799 URS procedures, 272 (5.6%) were done on patients taking chronic AC. Of 
      these, 193 (71%) held AC, 53 (19%) were bridged with enoxaparin, and 26 (10%) 
      continued AC. The median age was 70.2 years and the majority of patients (64.2%) 
      underwent a stone procedure with a stone-free rate of 73%. The overall 
      bleeding-related complication rate was 8.1% whereas the significant 
      bleeding-related event rate was 5.9%. Patients continuing AC had the highest 
      significant bleeding-related event rate at 15.4% compared to 9% and 3% for those 
      bridged with enoxaparin and those who held, respectively (P = .01). CONCLUSION: 
      Continuation or bridging of AC may increase the risk of perioperative bleeding. 
      The risks and benefits of proceeding with URS on AC must be weighed carefully. 
      Pending external validation, this information may be used for patient counseling 
      and risk stratification.
CI  - Copyright (c) 2016 Elsevier Inc. All rights reserved.
FAU - Westerman, Mary E
AU  - Westerman ME
AD  - Department of Urology, Mayo Clinic, Rochester, MN.
FAU - Scales, Joseph A
AU  - Scales JA
AD  - Department of Urology, Mayo Clinic, Rochester, MN.
FAU - Sharma, Vidit
AU  - Sharma V
AD  - Department of Urology, Mayo Clinic, Rochester, MN.
FAU - Gearman, Derek J
AU  - Gearman DJ
AD  - Department of Urology, Mayo Clinic, Rochester, MN.
FAU - Ingimarsson, Johann P
AU  - Ingimarsson JP
AD  - Department of Urology, Mayo Clinic, Rochester, MN; Maine Medical Center, South 
      Portland, ME.
FAU - Krambeck, Amy E
AU  - Krambeck AE
AD  - Department of Urology, Mayo Clinic, Rochester, MN; IU Health Physicians, 
      Indianapolis, IN. Electronic address: gecoots2@gmail.com.
LA  - eng
PT  - Journal Article
DEP - 20161005
PL  - United States
TA  - Urology
JT  - Urology
JID - 0366151
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 5Q7ZVV76EI (Warfarin)
SB  - IM
MH  - Aged
MH  - Anticoagulants/*therapeutic use
MH  - Blood Loss, Surgical/*statistics & numerical data
MH  - Drug Administration Schedule
MH  - Enoxaparin/therapeutic use
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Postoperative Hemorrhage/*epidemiology
MH  - Retrospective Studies
MH  - Ureteral Diseases/*surgery
MH  - Ureteroscopy/*adverse effects
MH  - Warfarin/therapeutic use
EDAT- 2016/10/11 06:00
MHDA- 2018/03/09 06:00
CRDT- 2016/10/11 06:00
PHST- 2016/07/30 00:00 [received]
PHST- 2016/09/19 00:00 [revised]
PHST- 2016/09/26 00:00 [accepted]
PHST- 2016/10/11 06:00 [pubmed]
PHST- 2018/03/09 06:00 [medline]
PHST- 2016/10/11 06:00 [entrez]
AID - S0090-4295(16)30653-7 [pii]
AID - 10.1016/j.urology.2016.09.034 [doi]
PST - ppublish
SO  - Urology. 2017 Feb;100:45-52. doi: 10.1016/j.urology.2016.09.034. Epub 2016 Oct 5.