With populations ageing and active treatment of urinary stones increasingly in demand, more patients with stones are presenting with an underlying bleeding disorder or need for regular thromboprophylaxis, by means of antiplatelet and other medication.
A practical guide to thromboprophylaxis in the treatment of urinary tract lithiasis has not yet been established. Patients can be stratified according to levels of risk of arterial and venous thromboembolism, which influence the requirements for antiplatelet and anticoagulant medications, respectively. Patients should also be stratified according to their risk of bleeding. Consideration of the combined risks of bleeding and thromboembolism should determine the perioperative thromboprophylactic strategy. The choice of shockwave lithotripsy, percutaneous nephrolithotomy or ureteroscopy with laser lithotripsy for treatment of lithiasis should be determined with regard to these risks. Although ureteroscopy is the preferred method in high-risk patients, shockwave lithotripsy and percutaneous nephrolithotomy can be chosen when indicated, if appropriate guidelines are strictly followed.
Written by:
Bourdoumis A, Stasinou T, Kachrilas S, Papatsoris AG, Buchholz N, Masood J. Are you the author?
Endourology and Stones Services, Barts Health NHS Trust, 9th Floor, Royal London Hospital, Whitechapel, London E1 1BB, UK; Department of Urology, North Devon District Hospital NHS Trust, Barnstaple, North Devon EX31 4HX, UK; 2nd Department of Urology, School of Medicine, University of Athens, Sismanoglio General Hospital, 1 Sismanogleiou Street, 14578 Athens, Greece.
Reference: Nat Rev Urol. 2013 Dec 17. Epub ahead of print.
doi: 10.1038/nrurol.2013.278
PubMed Abstract
PMID: 24346006
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