Ureteroscopy in Patients Taking Anticoagulant or Antiplatelet Therapy: Practice Patterns and Outcomes in a Surgical Collaborative.
Ureteroscopy in Patients Taking Anticoagulant or Antiplatelet Therapy: Practice Patterns and Outcomes in a Surgical Collaborative.
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DOI：
10.1097/ju.0000000000001416
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发表时间：
2021-03
期刊：
影响因子：
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通讯作者：
Ghani KR
中科院分区：
文献类型：
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作者：
Hiller SC;Qi J;Leavitt D;Frontera JR;Jafri SM;Hollingsworth JM;Dauw CA;Ghani KR
AUA指南建议将输尿管镜检(URS)作为接受抗凝(AC)或抗血小板(AP)治疗的患者的一线治疗，并倡导使用输尿管通路鞘(UAS)。我们检查了密歇根州这些患者的实践模式和计划外医疗保健利用情况。使用密歇根州泌尿外科改善合作(MUSIC)临床登记，我们确定了2016至2019年的URS病例。我们根据URS时的治疗评估结果和遵守指南：(1)AC：持续的华法林或新型口服药物治疗，(2)AP：持续的氯吡格雷或阿司匹林治疗，(3)对照：不接受AC/AP治疗。我们建立了多变量模型来评估AC或AP治疗与急诊科就诊、住院和UAS使用之间的关系。总共在31个实践中进行了9982次URS，其中AC和AP治疗分别占3.1%和7.8%。在AC/AP上进行URS时，无论容量大小，都有实践(0-21%)和外科医生(0-35%)的差异。在调整了危险因素后，AC或AP治疗与急症就诊无关。AC组、AP组和对照组的住院率分别为4.3%、5.5%和3.2%，AP治疗后住院率显著增加(OR1.48，95%CI：1.02~2.14)。实践水平的UAS使用情况各不相同(23%-100%)，与AC/AP治疗无关。局限性包括不能对AC/AP治疗的类型/剂量进行风险分层。我们发现，在AC/AP治疗期间进行URS时，实践和外科医生水平存在差异。URS治疗AC是安全的，但AP治疗增加了住院风险。尽管指南建议，UAS的使用与AC/AP治疗无关。
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. 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. 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. 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.