Safety of percutaneous nephrolithotomy in patients on antithrombotic therapy: a review of guidelines and recommendations.

With the expanding use of chronic antithrombotic medical management for coronary artery disease, surgeons face the growing challenge of balancing the risks of postoperative bleeding against perioperative cardiovascular events. Percutaneous nephrolithotomy (PCNL) carries a risk of bleeding and the need for transfusion at baseline, which is further increased in patients on anticoagulation and antiplatelet therapy. Broad perioperative recommendations for risk stratification and antithrombotic management exist for surgical patients, however, they are less clear in those undergoing PCNL. In this review we appraise available literature, guidelines and opinions and present a consensus statement for antithrombotic management in patients undergoing PCNL.