Objective: The study aimed to evaluate the true safety of transient cessation of the antiplatelet medication before extracorporeal shock wave lithotripsy (SWL) on bleeding-related complications. Patients and Methods: Forty cases undergoing SWL for renal pelvic stones were included and depending on the use of antiplatelet medication they were divided into 2 groups namely: group 1, cases under antiplatelet medication in whom the medication was stopped before ESWL; and group 2, cases without any antiplatelet medication. Comparative evaluation of patient, stone and treatment-related parameters were done in both groups. Results: Although microscopic hematuria was present in all cases, the incidence of macroscopic hematuria was higher in cases undergoing antiplatelet medication when compared with the other cases. Regarding the microscopic hematuria again, the mean number erythrocytes per field of analysis was significantly higher in group 1 cases. The mean value of the hematoma size was similar in both groups. Conclusion: Our findings indicate that SWL can be applied safely in patients under antiplatelet therapy following the cessation of medication for a certain period of time. However, among the cases treated with this concept in our study, we clearly observed that the incidence of procedure-related hematoma formation and macroscopic hematuria were more common in such cases than in the normal ones.

1.
Skolarikos A, Alivizatos G, de la Rosette J: Extracorporeal shock wave lithotripsy 25 years later: complications and their prevention. Eur Urol 2006;50:981-990.
2.
Sarica K, Yencilek F: Prevention of shockwave induced functional and morphological alterations: an overview. Arch Ital Urol Androl 2008;80:27-33.
3.
Riedler I, Trummer H, Hebel P, et al: Outcome and safety of extracorporeal shock wave lithotripsy as first-line therapy of lower pole nephrolithiasis. Urol Int 2003;71:350-354.
4.
Labanaris AP, Kühn R, Schott GE, et al: Perirenal hematomas induced by extracorporeal shock wave lithotripsy (ESWL). Therapeutic management. ScientificWorldJournal 2007;7:1563-1566.
5.
Cass AS, Brooker W, Duthoy E, et al: Clinically diagnosed renal hemorrhage after extracorporeal shock wave lithotripsy with Dornier HM3 and Medstone lithotripters. J Endourol 1992;6:413.
6.
Dhar NB, Thornton J, Karafa MT, et al: A multivariate analysis of risk factors associated with subcapsular hematoma formation following electromagnetic shock wave lithotripsy. J Urol 2004;172(6 pt 1):2271-2274.
7.
Dhar NB, Thornton J, Karafa MT, et al: A multivariate analysis of risk factors associated with subcapsular hematoma formation following electromagnetic shock wave lithotripsy. J Urol 2004;172(6 pt 1):2271-2274.
8.
Telegrafo M, Carluccio DA, Rella L, et al: Diagnostic and prognostic role of computed tomography in extracorporeal shock wave lithotripsy complications. Urol Ann 2016;8:168-172.
9.
Rnorr PA, Woodside JR: Large perirenal hematoma after extracorporeal shock-wave Iithotripsy. Urology 1990;35:151-153.
10.
Umekawa T, Yamate T, Amasaki N, et al: Continuous evaluation for retroperitoneal hematoma following extracorporeal shock wave lithotripsy. Urol Int 1993;51:114-116.
11.
Schnabel MJ, Gierth M, Bründl J, et al: Antiplatelet and anticoagulative medication during shockwave lithotripsy. J Endourol 2014;28:1034-1039.
12.
Alsaikhan B, Andonian S: Shock wave lithotripsy in patients requiring anticoagulation or antiplatelet agents. Can Urol Assoc J 2011;5:53-57.
13.
Evan AP, Willis LR, Connors BA, et al: Renal injury by extracorporeal shock wave lithotripsy. J Endourol 1991;5:25-35.
14.
Freund JB, Colonius T, Evan AP: A cumulative shear mechanism for tissue damage initiation in shock-wave lithotripsy. Ultrasound Med Biol 2007;33:1495-1503.
15.
Evan AP, Willis LR: Extracorporeal shockwave lithotripsy: complications; in Smith AD, Badlani G, Bagley D, et al (eds): Chapter 4: Smith's Textbook of Endourology. Hamilton, BC Decker, 2007, pp 353-368.
16.
Salem S, Mehrsai A, Zartab H, et al: Complications and outcomes following extracorporeal shock wave lithotripsy: a prospective study of 3,241 patients. Urol Res 2010;38:135-142.
17.
Madaan S, Joyce AD: Limitations of extracorporeal shock wave lithotripsy. Curr Opin Urol 2007;17:109-113.
18.
Newman LH, Saltzman B: Identifying risk factors in development of clinically significant post-shock-wave lithotripsy subcapsular hematomas. Urology 1991;38:35-38.
19.
Krishnamurthi V, Streem SB: Long-term radiographic and functional outcome of extracorporeal shock wave lithotripsy induced perirenal hematomas. J Urol 1995;154:1673-1675.
20.
Majerus PW, Broze GJ Jr, Miletich JP, et al: Anticoagulant, antithrombotic and thrombolytic drugs; in Hardman JG, Limbird LE, Molinoff PB, Ruddon RW (eds): Goodman & Gilman's The Pharmacological Basis of Therapeutics, ed 9. New York, McGraw-Hill, 1996, pp 1341-1359.
21.
Kennedy BM: Aspirin and surgery a review. Ir Med J 1984;77:363-369.
22.
Ferraris VA, Swanson E: Aspirin usage and perioperative blood loss in patients undergoing unexpected operations. Surg Gynecol Obstet 1983;156:439-442.
23.
Papanicolaou N, Stafford SA, Pfister RC, et al: Significant renal hemorrhage following extracorporeal shock wave lithotripsy: imaging and clinical features. Radiology 1987;163:661-664.
24.
Beving H, Zhao C, Albage A, et al: Abnormally high platelet activity after discontinuation of acetylsalicylic acid treatment. Blood Coagul Fibrinolysis 1996;7:80-84.
25.
Zanetti G, Kartalas-Goumas I, Montanari, et al: Extracorporeal shockwave lithotripsy in patients treated with antithrombotic agents. J Endourol 2001;15:237-241.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.