Ureteroscopy in Patients Receiving Systemic Anticoagulants: A Systematic Review and Meta-analysis of Safety, Efficacy, and Perioperative Management.
Anticoagulated patients had higher bleeding rates after ureteroscopy than controls in largest cohort.
Ureteroscopy in Patients Receiving Systemic Anticoagulants: A Systematic Review and Meta-analysis of Safety, Efficacy, and Perioperative Management.
To evaluate the safety and efficacy of ureteroscopy (ureteroscopy) in adults receiving systemic anticoagulant (anticoagulant) therapy, including vitamin K antagonists and direct oral anticoagulants (direct oral anticoagulants), compared with non-anticoagulant controls.
Using a Population, Intervention, Comparator, Outcomes (PICO) framework, we examined whether continuation, interruption, or peri-operative bridging of anticoagulant influences bleeding complications, thromboembolic events, and stone-free rates (stone-free rates) in adults undergoing ureteroscopy for stone disease.
EVIDENCE ACQUISITION: A systematic review of PubMed, Embase, and Scopus identified studies reporting ureteroscopy outcomes in anticoagulated patients.
anticoagulated patients bled more often after the procedure than non-anticoagulated patients
EVIDENCE SYNTHESIS: Eleven studies (1,516 anticoagulant patients; 20,708 controls) published between 1998 and 2024 met inclusion criteria.
Anticoagulation was not associated with a statistically significant increase in overall postoperative complications (RR 1.83, 95% CI 0.95-3.52).
Thirty-day readmission rates did not differ significantly (RR 1.59, 95% CI 0.27-9.29).
SFRs ranged between 70-97% across studies.
Bleeding complications were variably reported across studies, with several observational cohorts reporting higher absolute bleeding rates in anticoagulated patients than controls, although definitions were heterogeneous and absolute event rates were low.
Thromboembolic events were rare. Continuation may be justified in carefully selected high-thrombotic-risk patients.