Ureteroscopy in Patients Taking Anticoagulant or Antiplatelet Therapy: Practice Patterns and Outcomes in a Surgical Collaborative
Hiller SC, Qi J, Leavitt D, Frontera JR, Jafri SM, Hollingsworth JM, Dauw CA, and Ghani KR. Ureteroscopy in Patients Taking Anticoagulant or Antiplatelet Therapy: Practice Patterns and Outcomes in a Surgical Collaborative. J Urol 2020.
The Journal of urology
PURPOSE: AUA guidelines recommend ureteroscopy (URS) as first-line therapy for patients on anticoagulant (AC) or antiplatelet (AP) therapy, and advocate using a ureteral access sheath (UAS). We examined practice patterns and unplanned healthcare utilization in these patients in Michigan.
MATERIALS AND METHODS: Using the Michigan Urological Surgery Improvement Collaborative (MUSIC) clinical registry, we identified URS cases from 2016 to 2019. We assessed outcomes and adherence to guidelines based on therapy at time of URS: (1) AC: continuous warfarin or novel oral agent therapy, (2) AP: continuous clopidogrel or aspirin therapy, (3) Control: not on AC/AP therapy. We fit multivariate models to assess AC or AP therapy association with emergency department (ED) visits, hospitalization, and UAS use.
RESULTS: In total, 9982 URS were performed across 31 practices, with 3.1% and 7.8% on AC and AP therapy, respectively. There was practice (0-21%) and surgeon (0-35%) variation in performing URS on AC/AP, regardless of volume. After adjusting for risk factors, AC or AP therapy was not associated with ED visits. Hospitalization rates in AC, AP, and control groups were 4.3%, 5.5%, and 3.2%, respectively, and significantly increased with AP therapy (OR 1.48, 95% CI: 1.02-2.14). Practice-level UAS use varied (23-100%), and was not associated with AC/AP therapy. Limitations include inability to risk stratify between type/dosage of AC/AP therapy.
CONCLUSIONS: We found practice and surgeon-level variation in performing URS while on AC/AP therapy. URS on AC is safe, however AP therapy increases the risk of hospitalization. Despite guideline recommendations, UAS use is not associated with AC/AP therapy.
ePub ahead of print