Extracorporeal shockwave lithotripsy in patients treated with antithrombotic agents

Patients and Methods: Between January 1996 and December 1999, 749 patients underwent electromagnetic SWL. Among them, 23 patients, 19 with renal and 4 with ureteral stones, were receiving antithrombotic drugs (aspirin, ticlop idine, dipyridamole), According to the cardiologist and hematologist, we di vided these patients into two groups: Group 1 had a low thromboembolic risk (previous myocardial infarction), and Group 2 had a high thromboembolic ri sk (aortocoronary bypass, atrial fibrillation, cerebrovascular disease, per ipheral occlusive arterial disease), Group 1 patients discontinued their an tiplatelet therapy 8 days prior to SWL to permit a sufficient number of fun ctioning platelets to remain. Group 2 patients suspended antiplatelet thera py, and unfractioned heparin 5000 IU tid (8 a,m,, 4 p,m,, and 12 p,m,) was administered for the 8 days prior to SWL. On the ninth day of withdrawal, S WL was performed in all patients, Close follow-up was performed during the postoperative period (hemoglobin, hematocrit, kidney ultrasonography, plain abdominal film). The antithrombotic therapy was restored in all patients w ithin 10 to 14 days of withdrawal, Results: Hematomas and thromboembolic events were not observed, At 3 months ' follow-up, 14 patients (61%) were stone free, 3 (13%) had <4-mm fragments , and 6 (26%) had >4-mm residual fragments, Conclusion: Our schedules for the suspension or substitution of antithrombo tic therapy, although tested in a small number of patients, allowed us to p erform SWL without hemorrhagic or thromboembolic complications.