The Effect of Anticoagulation on Bleeding-related Complications Following Ureteroscopy

Mary E. Westerman, Joseph A. Scales, Vidit Sharma, Derek J. Gearman, Johann P. Ingimarsson, Amy Krambeck

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)45-52
Number of pages8
JournalUrology
Volume100
DOIs
StatePublished - Feb 1 2017

Fingerprint

Ureteroscopy
Hemorrhage
Enoxaparin
Platelet Aggregation Inhibitors
Warfarin
Anticoagulants
Counseling
Guidelines

ASJC Scopus subject areas

  • Urology

Cite this

Westerman, M. E., Scales, J. A., Sharma, V., Gearman, D. J., Ingimarsson, J. P., & Krambeck, A. (2017). The Effect of Anticoagulation on Bleeding-related Complications Following Ureteroscopy. Urology, 100, 45-52. https://doi.org/10.1016/j.urology.2016.09.034

The Effect of Anticoagulation on Bleeding-related Complications Following Ureteroscopy. / Westerman, Mary E.; Scales, Joseph A.; Sharma, Vidit; Gearman, Derek J.; Ingimarsson, Johann P.; Krambeck, Amy.

In: Urology, Vol. 100, 01.02.2017, p. 45-52.

Research output: Contribution to journalArticle

Westerman, Mary E. ; Scales, Joseph A. ; Sharma, Vidit ; Gearman, Derek J. ; Ingimarsson, Johann P. ; Krambeck, Amy. / The Effect of Anticoagulation on Bleeding-related Complications Following Ureteroscopy. In: Urology. 2017 ; Vol. 100. pp. 45-52.
@article{34f123ea10084f83bde832f8005b2cf6,
title = "The Effect of Anticoagulation on Bleeding-related Complications Following Ureteroscopy",
abstract = "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.",
author = "Westerman, {Mary E.} and Scales, {Joseph A.} and Vidit Sharma and Gearman, {Derek J.} and Ingimarsson, {Johann P.} and Amy Krambeck",
year = "2017",
month = "2",
day = "1",
doi = "10.1016/j.urology.2016.09.034",
language = "English (US)",
volume = "100",
pages = "45--52",
journal = "Urology",
issn = "0090-4295",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - The Effect of Anticoagulation on Bleeding-related Complications Following Ureteroscopy

AU - Westerman, Mary E.

AU - Scales, Joseph A.

AU - Sharma, Vidit

AU - Gearman, Derek J.

AU - Ingimarsson, Johann P.

AU - Krambeck, Amy

PY - 2017/2/1

Y1 - 2017/2/1

N2 - 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.

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.

UR - http://www.scopus.com/inward/record.url?scp=85006264270&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85006264270&partnerID=8YFLogxK

U2 - 10.1016/j.urology.2016.09.034

DO - 10.1016/j.urology.2016.09.034

M3 - Article

C2 - 27720775

AN - SCOPUS:85006264270

VL - 100

SP - 45

EP - 52

JO - Urology

JF - Urology

SN - 0090-4295

ER -