Introduction: The American Urological Association guidelines state that continuing anticoagulant (AC) and antiplatelet (AP) agents during ureteroscopy (URS) is safe. Through a multi-institutional retrospective study, we sought to determine whether pre-stenting in patients on AP or AC was associated with fewer URS bleeding-related complications. Methods: A series of 8614 URS procedures performed across three institutions (April 2010 to September 2017) was electronically reviewed for AC/AP use at time of URS. Records indicating AC or AP use at time of URS were then manually reviewed to characterize intraoperative and 30-day postoperative (intraoperative bleeding, postoperative hematuria, emergency department visits, hospital readmission, unplanned reoperation, phone calls, and other minor 30-day complications). Results: A total of 293 identified URS procedures were completed on patients on AC/AP therapy-112 cases were on AC only (38 were pre-stented), 158 on AP only (51 pre-stented), and 23 on both AP and AC (8 pre-stented). Patient characteristics and comorbidities were similar between the pre-stented and non-pre-stented groups. For AC and AP subjects, pre-stenting did not decrease the composite risk of bleeding complications (10.3% pre-stent vs 12.2% non-prestent, p = 0.6). Pre-stented patients did have a significantly lower likelihood of requiring an unplanned reoperation (1.0% vs 5.6%, p = 0.04). In the subgroup of patients on AP alone, pre-stented patients had significantly fewer episodes of intraoperative bleeding (0% vs 9%, p = 0.04), unplanned reoperations (0% vs 6.5%, p = 0.02), and 30-day complications (14% vs 27%, p = 0.05). In the subgroup of patients on AC alone, there were no significant differences in outcomes based on stent status. Conclusions: In this multi-institutional study, we found that pre-stenting before URS was not associated with fewer bleeding complications. However, pre-stenting appeared to be associated with improved outcomes for those patients on AP therapy. These results suggest a need for prospective studies to clarify the role of pre-stenting for URS.

中文翻译：

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预置支架对接受抗凝或抗血小板治疗的患者输尿管镜检查后出血相关并发症的影响。

简介：美国泌尿外科协会指南指出，输尿管镜检查 (URS) 期间持续使用抗凝 (AC) 和抗血小板 (AP) 药物是安全的。通过一项多机构回顾性研究，我们试图确定接受 AP 或 AC 的患者预置支架是否与减少 URS 出血相关并发症有关。方法：对三个机构（2010 年 4 月至 2017 年 9 月）执行的一系列 8614 URS 程序进行电子审查，以了解 URS 时 AC/AP 的使用情况。然后手动审查 URS 时使用 AC 或 AP 的记录，以描述术中和术后 30 天的特征（术中出血、术后血尿、急诊科就诊、再入院、计划外再次手术、电话和其他 30 天的轻微并发症） 。结果：接受 AC/AP 治疗的患者总共完成了 293 例已确定的 URS 手术，其中 112 例仅接受 AC（38 例预先置有支架），158 例仅接受 AP（51 例预先置有支架），23 例同时接受 AP 和 AP 治疗。 AC（8 个预支架）。置入支架组和未置入支架组的患者特征和合并症相似。对于 AC 和 AP 受试者，支架置入前并未降低出血并发症的综合风险（支架置入前为 10.3%，未置入支架为 12.2%，p = 0.6）。已置入支架的患者确实需要计划外再次手术的可能性显着降低（1.0% vs 5.6%，p = 0.04）。在仅接受 AP 治疗的患者亚组中，已置入支架的患者术中出血（0% vs 9%，p = 0.04）、计划外再次手术（0% vs 6.5%，p = 0.02）和 30 天的发生率显着减少并发症（14% vs 27%，p = 0.05）。在仅接受 AC 治疗的患者亚组中，基于支架状态的结果没有显着差异。结论：在这项多机构研究中，我们发现 URS 前预先置入支架与减少出血并发症无关。然而，预置支架似乎与接受 AP 治疗的患者的预后改善相关。这些结果表明需要进行前瞻性研究来阐明预支架置入术对 URS 的作用。