The Safety of Continuing Low-dose Aspirin Therapy Perioperatively in the Patients had Undergone Percutaneous Nephrolithotomy: A Systematic Review and Meta-analysis

Aspirin (ASA) is often stopped prior to percutaneous nephrolithotomy (PCNL) due to the surgical bleeding risk. However, this practice is based on expert opinion only, and mounting evidence suggests holding aspirin perioperatively can be more harmful than once thought. In our review we aimed to discuss the safety of low dose aspirin continued or discontinued in the whole perioperative period of PCNL.

We performed a computerized PubMed, EMBASE and Cochrane Library search of relevant studies. Study identification satisfied the PRISMA guidelines. Newcastle-Ottawa scale (NOS) was used to evaluate the quality of including studies. Favored outcomes such as operative time, complications and change in hemoglobin were extracted. Statistical analysis was performed with Rev-Man software 5.3 and forest plots were used to illustrate our findings.

After screening, four studies were included in the present systematic review. There was no difference in the number of total complications (OR:1.25; 95 % CI 0.82-1.90; p=0.30), major complications (OR: 1.24; 95 % CI 0.53-2.93; p=0.62) and blood transfusion rate (OR:0.99; 95 % CI 0.46-2.12; p=0.98) between the continuing low dose aspirin group and discontinuing group. Moreover, the overall stone-free rate was also not statistically significant (OR:3.17; 95 % CI 0.89-11.25; p=0.07). It was similar about the change in hemoglobin, hematocrit and creatinine levels between two groups.

Based on our findings, transient cessation of aspirin perioperatively seems not to be necessary for patients who need PCNL complicated with the necessity of aspirin therapy. However, further well-designed prospective studies with large sample size are needed to confirm and validate our findings.