Abstract
Purpose
To investigate the risk of renal hematoma (RHT) after shock wave lithotripsy (SWL) among patients on acetylsalicylic acid (ASA) or low-molecular-weight heparin (LMWH).
Patients and methods
Retrospective analysis of 434 patients treated with SWL for nephrolithiasis and ureterolithiasis of the proximal ureter. Primary endpoint was detection of RHT by ultrasound the day after SWL. Secondary outcome variables included transfusion of erythrocyte concentrate(s), interventions, hospital readmission or death due to RHT within 30 days of SWL. Binary logistic regression analysis was used including a post hoc one-way analysis.
Results
Of 434 patients, 33 (7.6%) and 67 (15.4%) patients were medicated with ASA and LMWH, respectively. RHT was detected in 20 of 434 (4.6%) patients. Of those, 3 (20%) were on ASA, 6 (35%) were on LMWH, 1 (5%) was on ASA and LMWH, and 10 (50%) had no anticoagulation. Univariate analysis showed a statistically significant higher risk for RHT among patients on ASA (p = 0.04) and LWMH (p = 0.02) with an untreated urinary tract infection (UTI) (p = 0.008) and history of cardiovascular disease (p = 0.028). On multivariate analysis, ASA medication, untreated UTI (OR 4.4, 95% CI 1.31–14.75, p = 0.016 and OR 5.79, 95% CI 1.65–20.32, p = 0.03) and a therapeutic dose of LMWH (OR 10.4, 95% CI 1.74–62.27, p = 0.01) were independent predictors for RHT.
Conclusions
Before SWL, a patient risk profile should be evaluated. If feasible, LMWH in therapeutic dosing should be avoided, and ASA should be discontinued. UTI should be treated before SWL in any case.
Trial registration
http://www.clinicaltrials.gov; Identifier NCT02875717.
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Acknowledgements
The authors would like to acknowledge the whole team involved in the processing of this study, particularly Michael Haessig, V.M.D., Vetsuisse faculty, University of Zurich, for providing assistance on the statistical methodology. The preliminary results of this paper have been presented as a poster at the Annual Congress of the European Association of Urology (EAU) in London March 2017, the Annual Congress of the American Urological Association (AUA) in San Diego May 2016 and the Annual Congress of the German Urological Society (DGU) in Hamburg September 2015.
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CS: protocol/project development, data collection or management, data analysis, manuscript writing. HJ: protocol/project development, manuscript editing. IK: protocol/project development, data analysis, manuscript editing. MR: protocol/project development, data analysis, manuscript editing.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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Schregel, C., John, H., Randazzo, M. et al. Influence of acetylsalicylic acid and low-molecular weight heparins on the formation of renal hematoma after shock wave lithotripsy. World J Urol 35, 1939–1946 (2017). https://doi.org/10.1007/s00345-017-2070-0
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DOI: https://doi.org/10.1007/s00345-017-2070-0