Antikoagülan ve Antiagregan İlaç Kullanan Hastalarda Perkütan Nefrolitotomi (PNL) Operasyonu; Preop Hasta Hazırlıkve Postop Takip Süreci
Özet
Böbrek taşı tedavisinde kullanılan perkütan nefrolitotomi (PNL), özellikle büyük ve komplike taşların çıkarılmasında etkili bir yöntemdir. Ancak bu cerrahi prosedür nispeten yüksek kanama riski taşır. Bu risk, antiagregan ve antikoagülan kullanan hastalarda daha da artar, çünkü bu ilaçlar kanın pıhtılaşma yeteneğini azaltarak kanama olasılığını yükseltir. PNL uygulanacak hastalarda antiagregan ve antikoagülan tedavi yönetimi dikkatli bir şekilde planlanmalıdır. Cerrahi öncesi dönemde, hastaların kullandığı bu ilaçlar genellikle prosedürden 5-7 gün önce kesilmelidir. Bu süreçte, hastaların kardiyoloji uzmanlarıyla iş birliği yapılarak ilaçların kesilmesi ve yeniden başlanması konusunda detaylı bir değerlendirme yapılmalıdır.
Operasyon sırasında ve sonrasında, kanama kontrolü için dikkatli bir hemostaz sağlanmalı ve hastalar yakından izlenmelidir. Prosedür sonrası dönemde, yeniden başlanan antiagregan ve antikoagülan tedavisi, cerrahi bölgenin iyileşmesi ve kanama riskinin minimize edilmesi için optimize edilmelidir. Ayrıca, PNL uygulanan bu hasta grubunda kanama komplikasyonlarının yönetimi için hazır olunmalı ve gerektiğinde kan transfüzyonu veya diğer hemostatik tedaviler hızla uygulanmalıdır.
Sonuç olarak, antiagregan ve antikoagülan kullanan hastalarda PNL yönetimi, multidisipliner bir yaklaşım gerektirir. Bu ilaçların cerrahi öncesi ve sonrası dikkatli yönetimi, kanama riskini azaltmada ve başarılı bir cerrahi sonuç elde etmede kritik öneme sahiptir.
Percutaneous nephrolithotomy (PNL), used in the treatment of kidney stones, is particularly effective for removing large and complex stones. However, this surgical procedure carries a relatively high risk of bleeding. This risk is further increased in patients using antiplatelet and anticoagulant medications, as these drugs reduce the blood's ability to clot, increasing the likelihood of bleeding. The management of PNL in patients on antiplatelet and anticoagulant therapy requires careful planning. Typically, these medications are discontinued 5-7 days before the procedure. During this period, a detailed evaluation should be conducted in collaboration with cardiology specialists to determine the safest approach for discontinuing and resuming these medications.
During and after the surgery, meticulous hemostasis is crucial, and patients should be closely monitored. In the postoperative period, restarting antiplatelet and anticoagulant therapy should be optimized to minimize bleeding risk while ensuring proper healing of the surgical site. Additionally, managing bleeding complications in this patient group should be prepared for, with the readiness to provide blood transfusions or other hemostatic treatments as needed.
In conclusion, the management of PNL in patients on antiplatelet and anticoagulant therapy requires a multidisciplinary approach. Careful management of these medications before and after surgery is critical in reducing bleeding risk and achieving successful surgical outcomes.
Referanslar
Sorokin I, Mamoulakis C, Miyazawa K, Rodgers A, Talati J, Lotan Y. Epidemiology of stone disease across the world. World J Urol. 2017 Sep 17;35(9):1301–20.
Muslumanoglu AY, Binbay M, Yuruk E, Akman T, Tepeler A, Esen T, et al. Updated epidemiologic study of urolithiasis in Turkey. I: Changing characteristics of urolithiasis. Urol Res. 2011 Aug 16;39(4):309–14.
Culkin DJ, Exaire EJ, Green D, Soloway MS, Gross AJ, Desai MR, et al. Anticoagulation and Antiplatelet Therapy in Urological Practice: ICUD/AUA Review Paper. Journal of Urology. 2014 Oct;192(4):1026–34.
Akram M, Jahrreiss V, Skolarikos A, Geraghty R, Tzelves L, Emilliani E, et al. Urological Guidelines for Kidney Stones: Overview and Comprehensive Update. J Clin Med. 2024 Feb 16;13(4):1114.
Fernström I, Johansson B. Percutaneous Pyelolithotomy. Scand J Urol Nephrol. 1976 Jan 1;10(3):257–9.
Ghani KR, Andonian S, Bultitude M, Desai M, Giusti G, Okhunov Z, et al. Percutaneous Nephrolithotomy: Update, Trends, and Future Directions. Eur Urol. 2016 Aug;70(2):382–96.
Wong Y, Cook P, Roderick P, Somani BK. Metabolic Syndrome and Kidney Stone Disease: A Systematic Review of Literature. J Endourol. 2016 Mar;30(3):246–53.
LIATSIKOS E, KAPOOR R, LEE B, JABBOUR M, BARBALIAS G, SMITH A. “Angular Percutaneous Renal Access”. Multiple Tracts Through A Single Incision for Staghorn Calculous Treatment in A Single Session. Eur Urol. 2005 Nov;48(5):832–7.
Stoller ML, Wolf JS, St. Lezin MA. Estimated Blood Loss and Transfusion Rates Associated with Percutaneous Nephrolithotomy. Journal of Urology. 1994 Dec;152(6 Part 1):1977–81.
Kukreja R, Desai M, Patel S, Bapat S, Desai M. First Prize: Factors Affecting Blood Loss During Percutaneous Nephrolithotomy: Prospective Study. J Endourol. 2004 Oct;18(8):715–22.
Muslumanoglu AY, Tefekli A, Karadag MA, Tok A, Sari E, Berberoglu Y. Impact of Percutaneous Access Point Number and Location on Complication and Success Rates in Percutaneous Nephrolithotomy. Urol Int. 2006;77(4):340–6.
Davidoff R, Bellman GC. Influence of technique of percutaneous tract creation on incidence of renal hemorrhage. J Urol. 1997 Apr;157(4):1229–31.
Li Z, Wu A, Liu J, Huang S, Chen G, Wu Y, et al. Risk factors for hemorrhage requiring embolization after percutaneous nephrolithotomy: a meta-analysis. Transl Androl Urol. 2020 Apr;9(2):210–7.
Excellence Commission C. GUIDELINES ON PERIOPERATIVE MANAGEMENT OF ANTICOAGULANT AND ANTIPLATELET AGENTS [Internet]. 2018. Available from: http://www.cec.health.nsw.gov.au/
Kearon C, Hirsh J. Management of Anticoagulation before and after Elective Surgery. New England Journal of Medicine. 1997 May 22;336(21):1506–11.
Douketis JD, Spyropoulos AC, Spencer FA, Mayr M, Jaffer AK, Eckman MH, et al. Perioperative Management of Antithrombotic Therapy. Chest. 2012 Feb;141(2):e326S-e350S.
Samama CM, Djoudi R, Lecompte T, Nathan N, Schved JF, French Health Products Safety Agency (AFSSAPS) Expert Group. Perioperative platelet transfusion. Recommendations of the French Health Products Safety Agency (AFSSAPS) 2003. Minerva Anestesiol. 2006 Jun;72(6):447–52.
Chassot PG, Delabays A, Spahn DR. Perioperative antiplatelet therapy: the case for continuing therapy in patients at risk of myocardial infarction. Br J Anaesth. 2007 Sep;99(3):316–28.
Li L, Zhang Y, Chen Y, Zhu KS, Chen DJ, Zeng XQ, et al. A multicentre retrospective study of transcatheter angiographic embolization in the treatment of delayed haemorrhage after percutaneous nephrolithotomy. Eur Radiol. 2015 Apr 24;25(4):1140–7.
El Tayeb MM, Knoedler JJ, Krambeck AE, Paonessa JE, Mellon MJ, Lingeman JE. Vascular Complications After Percutaneous Nephrolithotomy: 10 Years of Experience. Urology. 2015 Apr;85(4):777–81.
Referanslar
Sorokin I, Mamoulakis C, Miyazawa K, Rodgers A, Talati J, Lotan Y. Epidemiology of stone disease across the world. World J Urol. 2017 Sep 17;35(9):1301–20.
Muslumanoglu AY, Binbay M, Yuruk E, Akman T, Tepeler A, Esen T, et al. Updated epidemiologic study of urolithiasis in Turkey. I: Changing characteristics of urolithiasis. Urol Res. 2011 Aug 16;39(4):309–14.
Culkin DJ, Exaire EJ, Green D, Soloway MS, Gross AJ, Desai MR, et al. Anticoagulation and Antiplatelet Therapy in Urological Practice: ICUD/AUA Review Paper. Journal of Urology. 2014 Oct;192(4):1026–34.
Akram M, Jahrreiss V, Skolarikos A, Geraghty R, Tzelves L, Emilliani E, et al. Urological Guidelines for Kidney Stones: Overview and Comprehensive Update. J Clin Med. 2024 Feb 16;13(4):1114.
Fernström I, Johansson B. Percutaneous Pyelolithotomy. Scand J Urol Nephrol. 1976 Jan 1;10(3):257–9.
Ghani KR, Andonian S, Bultitude M, Desai M, Giusti G, Okhunov Z, et al. Percutaneous Nephrolithotomy: Update, Trends, and Future Directions. Eur Urol. 2016 Aug;70(2):382–96.
Wong Y, Cook P, Roderick P, Somani BK. Metabolic Syndrome and Kidney Stone Disease: A Systematic Review of Literature. J Endourol. 2016 Mar;30(3):246–53.
LIATSIKOS E, KAPOOR R, LEE B, JABBOUR M, BARBALIAS G, SMITH A. “Angular Percutaneous Renal Access”. Multiple Tracts Through A Single Incision for Staghorn Calculous Treatment in A Single Session. Eur Urol. 2005 Nov;48(5):832–7.
Stoller ML, Wolf JS, St. Lezin MA. Estimated Blood Loss and Transfusion Rates Associated with Percutaneous Nephrolithotomy. Journal of Urology. 1994 Dec;152(6 Part 1):1977–81.
Kukreja R, Desai M, Patel S, Bapat S, Desai M. First Prize: Factors Affecting Blood Loss During Percutaneous Nephrolithotomy: Prospective Study. J Endourol. 2004 Oct;18(8):715–22.
Muslumanoglu AY, Tefekli A, Karadag MA, Tok A, Sari E, Berberoglu Y. Impact of Percutaneous Access Point Number and Location on Complication and Success Rates in Percutaneous Nephrolithotomy. Urol Int. 2006;77(4):340–6.
Davidoff R, Bellman GC. Influence of technique of percutaneous tract creation on incidence of renal hemorrhage. J Urol. 1997 Apr;157(4):1229–31.
Li Z, Wu A, Liu J, Huang S, Chen G, Wu Y, et al. Risk factors for hemorrhage requiring embolization after percutaneous nephrolithotomy: a meta-analysis. Transl Androl Urol. 2020 Apr;9(2):210–7.
Excellence Commission C. GUIDELINES ON PERIOPERATIVE MANAGEMENT OF ANTICOAGULANT AND ANTIPLATELET AGENTS [Internet]. 2018. Available from: http://www.cec.health.nsw.gov.au/
Kearon C, Hirsh J. Management of Anticoagulation before and after Elective Surgery. New England Journal of Medicine. 1997 May 22;336(21):1506–11.
Douketis JD, Spyropoulos AC, Spencer FA, Mayr M, Jaffer AK, Eckman MH, et al. Perioperative Management of Antithrombotic Therapy. Chest. 2012 Feb;141(2):e326S-e350S.
Samama CM, Djoudi R, Lecompte T, Nathan N, Schved JF, French Health Products Safety Agency (AFSSAPS) Expert Group. Perioperative platelet transfusion. Recommendations of the French Health Products Safety Agency (AFSSAPS) 2003. Minerva Anestesiol. 2006 Jun;72(6):447–52.
Chassot PG, Delabays A, Spahn DR. Perioperative antiplatelet therapy: the case for continuing therapy in patients at risk of myocardial infarction. Br J Anaesth. 2007 Sep;99(3):316–28.
Li L, Zhang Y, Chen Y, Zhu KS, Chen DJ, Zeng XQ, et al. A multicentre retrospective study of transcatheter angiographic embolization in the treatment of delayed haemorrhage after percutaneous nephrolithotomy. Eur Radiol. 2015 Apr 24;25(4):1140–7.
El Tayeb MM, Knoedler JJ, Krambeck AE, Paonessa JE, Mellon MJ, Lingeman JE. Vascular Complications After Percutaneous Nephrolithotomy: 10 Years of Experience. Urology. 2015 Apr;85(4):777–81.
