Antitrombotik Tedavi Acil Perkütan Nefrostomiyi Tehlikeye Atmaz

Year 2025, Volume: 20 Issue: 1, 13 - 20, 27.02.2025

Şahin Kılıç , Ahmet Sukru Alparslan , Engin Kölükçü , Çağatay Özsoy , Murat Şambel , Selim Taş

https://doi.org/10.33719/nju1603500

Abstract

Amaç: Bu çalışmada, antitrombotik (antiagregan ve antikoagülan) tedavi altında komplike üst üriner sistem enfeksiyonu nedeniyle acil perkütan nefrostomi (PN) uygulanan hastaların sonuçlarının değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntemler: Ocak 2014 ile Ekim 2024 tarihleri arasında acil PN uygulanan ardışık hastaların verileri retrospektif olarak incelendi. Antitrombotik tedavi gören 34 hasta (Grup 1) ve kanama bozukluğu veya antitrombotik tedavisi olmayan 35 kontrol grubu hastası (Grup 2) dahil edildi. Demografik özellikler, PN endikasyonları, işlem öncesi ve sonrası hematolojik, biyokimyasal ve mikrobiyolojik parametreler ve komplikasyonlar analiz edildi.
Bulgular: Ortalama yaş grup 1'de 67.82±9.73 ve grup 2'de 63.06±11.58 idi (p=0.006). Cinsiyet dağılımı ve PN endikasyonları gruplar arasında benzerdi. Acil PN endikasyonları, hidronefroz dereceleri ve PN yerleştirme tarafları arasında anlamlı fark yoktu. Grup 1'de en sık kullanılan antitrombotik varfarin idi (%44,1). Escherichia coli her iki grupta da en sık izole edilen bakteriydi (grup 1 ve 2 için sırasıyla %55,9 ve %48,6). PN işlemi sonrasında her iki grupta da majör komplikasyon gözlenmedi. Grup 1 ve 2'de sırasıyla 4 ve 3 hastaya kan replasmanı yapıldı. İşlem sonrası ortalama Hg seviyeleri her iki grupta da benzerdi (grup 1 ve 2 için sırasıyla 9.53 ±1.39 ve 9.98 ±1.18). Gruplar arasında medyan hastanede kalış süresi açısından fark gözlenmedi.
Sonuçlar: Antitrombotik ilaçlar PN yerleştirilmesi sırasında potansiyel kanama riski oluşturmaktadır. Bu çalışma antitrombotik tedavi alan hastalarda PN yerleştirilmesi ile ilgili literatürdeki ilk çalışmadır ve antitrombotik tedavi alan hastalarda işlemin düşük komplikasyon oranları ile gerçekleştirilebileceğini göstermektedir.

Keywords

Antiagregan, Antikoagülan, Amfizematöz pyelonefrit, Perkütan nefrostomi, Pyelonefroz, Ürolojik acil.

Antithrombotic Therapy Does Not Jeopardize Emergency Percutaneous Nephrostomy

Abstract

Objective: This study aims to evaluate the outcomes of patients on antithrombotic (antiaggregant and anticoagulant) therapy who underwent emergency percutaneous nephrostomy (PN) for complicated upper urinary tract infection.
Materials and Methods: Data from consecutive patients who underwent emergency PN from January 2014 to October 2024 were retrospectively reviewed. A total of 34 patients on antithrombotic treatment (Group 1) and 35 control group patients (Group 2) without bleeding disorders or antithrombotic treatment were included. Demographics, PN indications, pre- and post-procedural haematological, biochemical, and microbiological parameters and complications were analysed.
Results: The mean age was 67.82±9.73 in group 1 and 63.06±11.58 in group 2 (p=0.006). Sex distribution and indications for PN were comparable between groups. There was no significant difference in emergency PN indications, hydronephrosis grades, and PN placement sides. The most common antithrombotic in group 1 was warfarin (44.1 %). Escherichia coli was the most frequently isolated bacteria in both groups (55.9% vs. 48.6 % for groups 1 and 2, respectively). No major complication was observed in both groups after PN procedure. Blood replacement was performed in 4 and 3 patients in groups 1 and 2, respectively. Post-procedure mean Hg levels were similar in both groups (9.53 ±1.39 vs. 9.98 ±1.18 for groups 1 and 2, respectively). No difference in median hospital stay was observed between the groups.
Conclusion: Antithrombotic drugs pose potential bleeding risks during PN placement. This is the first study in the literature on PN placement in patients on antithrombotic therapy and it indicates that the procedure can be performed with low complication rates in patients on antithrombotic therapy.

Keywords

Antiaggregant, Anticoagulant, Emphysematous pyelonephritis, Percutaneous nephrostomy, Pyelonephrosis, Urological emergency.

Ethical Statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional (Antalya Training and Research Hospital, Approval No: 11/15, date 24.08.2023.) and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Supporting Institution

This study was not supported by any funding.

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