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Continuing aspirin use appears safe in patients undergoing PCNL


"We did not find that there were any clotting or thrombotic complications in those who did stop their aspirin," says Smita De, MD, PhD.

In this video, Smita De, MD, PhD, shares the background and notable findings from the recent Urology study “Is it Safe to Continue Aspirin in Patients Undergoing Percutaneous Nephrolithotomy?” De is a staff physician at the Glickman Urological & Kidney Institute at Cleveland Clinic, Cleveland, Ohio and a clinical assistant professor of urology at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.


Please describe the background for this study.

This was a very organically developed study. I had a patient who needed a PCNL, but she needed to stay on her aspirin because of her other medical issues. In my training, we had always held any blood thinners, whether it was aspirin or one of the other anticoagulants, anytime we did a PCNL. That's just how I trained and what I was used to, so I got really nervous about this idea of continuing her on aspirin. I started looking at the literature, and it was fairly scant at the time in terms of whether it was safe to do PCNL on patients who were on blood thinners and very specifically aspirin. I also asked a lot of my colleagues and I got an enormous variation in responses. And so I thought, well, this seems like an opportunity. And at our own institution, which is really high volume, the practice seems to have varied a lot over the years. So I thought, let's look at our patients. And that's really where the cohort for this study came from.

What were some of the notable findings? Were any of them surprising to you and your coauthors?

I would say, after having looked at the literature and talked to my colleagues, what we were really interested in is patients who are on long-term aspirin for whatever reasons that might be. Are they safe to continue that aspirin when they have a PCNL? And so we wanted to look at a couple of different things. The most obvious thing is bleeding events in those who continue their aspirin, but simultaneously look at, do patients who stop their aspirin end up having the opposite type of complication; do they have a thrombotic or a clot type of complication? Why are they on aspirin to begin with. That's why we picked patients specifically who were on chronic aspirin for whatever their medical condition is. We actually found that there was no difference either in bleeding complications, so including need for transfusions, ER visits, hospital admissions, we found no difference in the patients who continued aspirin vs those who stopped their aspirin for surgery. And similarly, we did not find that there were any clotting or thrombotic complications in those who did stop their aspirin. I wouldn't necessarily say it was surprising; I think it was reassuring in a lot of ways. It's reassuring in that people have been doing it both ways. And also, we know that other urologic procedures, including prostate biopsies, are done with people who continue aspirin. I don't think it was surprising as much as it was reassuring. We did see, though, that those patients who continued aspirin did have more underlying health issues. They were more likely to have a smoking history, which would tie back into having more health issues, and then did tend to stay in the hospital a little bit longer. But we're talking about a matter of hours, not days. Overall, our data suggest that it is safe to continue aspirin in the setting of a PCNL.

This transcription was edited for clarity.

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