Ureteroscopy in Patients Taking Anticoagulant or Antiplatelet Therapy: Practice Patterns and Outcomes in a Surgical Collaborative.
Identifieur interne : 000006 ( Main/Exploration ); précédent : 000005; suivant : 000007Ureteroscopy in Patients Taking Anticoagulant or Antiplatelet Therapy: Practice Patterns and Outcomes in a Surgical Collaborative.
Auteurs : Spencer C. Hiller [États-Unis] ; Ji Qi [États-Unis] ; David Leavitt [États-Unis] ; J Rene Frontera [États-Unis] ; S Mohammad Jafri [États-Unis] ; John M. Hollingsworth [États-Unis] ; Casey A. Dauw [États-Unis] ; Khurshid R. Ghani [États-Unis]Source :
- The Journal of urology [ 1527-3792 ] ; 2021.
Abstract
PURPOSE
AUA guidelines recommend ureteroscopy as first line therapy for patients on anticoagulant or antiplatelet therapy and advocate using a ureteral access sheath. We examined practice patterns and unplanned health care use for these patients in Michigan.
MATERIALS AND METHODS
Using the Michigan Urological Surgery Improvement Collaborative (MUSIC) clinical registry we identified ureteroscopy cases from 2016 to 2019. We assessed outcomes and adherence to guidelines based on therapy at time of ureteroscopy: 1) anticoagulant: continuous warfarin or novel oral agent therapy; 2) antiplatelet: continuous clopidogrel or aspirin therapy; 3) control: not on anticoagulant/antiplatelet therapy. We fit multivariate models to assess anticoagulant or antiplatelet therapy association with emergency department visits, hospitalization and ureteral access sheath use.
RESULTS
In total, 9,982 ureteroscopies were performed across 31 practices with 3.1% and 7.8% on anticoagulant and antiplatelet therapy, respectively. There were practice (0% to 21%) and surgeon (0% to 35%) variations in performing ureteroscopy on patients on anticoagulant/antiplatelet therapy regardless of volume. After adjusting for risk factors, anticoagulant or antiplatelet therapy was not associated with emergency department visits. Hospitalization rates in anticoagulant, antiplatelet and control groups were 4.3%, 5.5% and 3.2%, respectively, and significantly increased with antiplatelet therapy (OR 1.48, 95% CI 1.02-2.14). Practice-level ureteral access sheath use varied (23% to 100%) and was not associated with anticoagulant/antiplatelet therapy. Limitations include inability to risk stratify between type/dosage of anticoagulant/antiplatelet therapy.
CONCLUSIONS
We found practice-level and surgeon-level variation in performing ureteroscopy while on anticoagulant/antiplatelet therapy. Ureteroscopy on anticoagulant is safe. However, antiplatelet therapy increases the risk of hospitalization. Despite guideline recommendations, ureteral access sheath use is not associated with anticoagulant/antiplatelet therapy.
DOI: 10.1097/JU.0000000000001416
PubMed: 33035142
Affiliations:
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Hiller</name><affiliation wicri:level="2"><nlm:affiliation>Department of Urology, University of Michigan, Ann Arbor, Michigan.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea>Department of Urology, University of Michigan, Ann Arbor</wicri:cityArea></affiliation></author><author><name sortKey="Qi, Ji" sort="Qi, Ji" uniqKey="Qi J" first="Ji" last="Qi">Ji Qi</name><affiliation wicri:level="2"><nlm:affiliation>Department of Urology, University of Michigan, Ann Arbor, Michigan.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea>Department of Urology, University of Michigan, Ann Arbor</wicri:cityArea></affiliation></author><author><name sortKey="Leavitt, David" sort="Leavitt, David" uniqKey="Leavitt D" first="David" last="Leavitt">David Leavitt</name><affiliation wicri:level="2"><nlm:affiliation>Department of Urology, Henry Ford Hospital, Detroit, Michigan.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea>Department of Urology, Henry Ford Hospital, Detroit</wicri:cityArea></affiliation></author><author><name sortKey="Frontera, J Rene" sort="Frontera, J Rene" uniqKey="Frontera J" first="J Rene" last="Frontera">J Rene Frontera</name><affiliation wicri:level="2"><nlm:affiliation>Michigan Institute of Urology, Troy, Michigan.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea>Michigan Institute of Urology, Troy</wicri:cityArea></affiliation></author><author><name sortKey="Jafri, S Mohammad" sort="Jafri, S Mohammad" uniqKey="Jafri S" first="S Mohammad" last="Jafri">S Mohammad Jafri</name><affiliation wicri:level="2"><nlm:affiliation>William Beaumont Hospital, Royal Oak, Michigan.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea>William Beaumont Hospital, Royal Oak</wicri:cityArea></affiliation></author><author><name sortKey="Hollingsworth, John M" sort="Hollingsworth, John M" uniqKey="Hollingsworth J" first="John M" last="Hollingsworth">John M. 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Ghani</name><affiliation wicri:level="2"><nlm:affiliation>Department of Urology, University of Michigan, Ann Arbor, Michigan.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea>Department of Urology, University of Michigan, Ann Arbor</wicri:cityArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2021">2021</date><idno type="RBID">pubmed:33035142</idno><idno type="pmid">33035142</idno><idno type="doi">10.1097/JU.0000000000001416</idno><idno type="wicri:Area/Main/Corpus">000143</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000143</idno><idno type="wicri:Area/Main/Curation">000143</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Curation">000143</idno><idno type="wicri:Area/Main/Exploration">000143</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Ureteroscopy in Patients Taking Anticoagulant or Antiplatelet Therapy: Practice Patterns and Outcomes in a Surgical Collaborative.</title><author><name sortKey="Hiller, Spencer C" sort="Hiller, Spencer C" uniqKey="Hiller S" first="Spencer C" last="Hiller">Spencer C. Hiller</name><affiliation wicri:level="2"><nlm:affiliation>Department of Urology, University of Michigan, Ann Arbor, Michigan.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea>Department of Urology, University of Michigan, Ann Arbor</wicri:cityArea></affiliation></author><author><name sortKey="Qi, Ji" sort="Qi, Ji" uniqKey="Qi J" first="Ji" last="Qi">Ji Qi</name><affiliation wicri:level="2"><nlm:affiliation>Department of Urology, University of Michigan, Ann Arbor, Michigan.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea>Department of Urology, University of Michigan, Ann Arbor</wicri:cityArea></affiliation></author><author><name sortKey="Leavitt, David" sort="Leavitt, David" uniqKey="Leavitt D" first="David" last="Leavitt">David Leavitt</name><affiliation wicri:level="2"><nlm:affiliation>Department of Urology, Henry Ford Hospital, Detroit, Michigan.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea>Department of Urology, Henry Ford Hospital, Detroit</wicri:cityArea></affiliation></author><author><name sortKey="Frontera, J Rene" sort="Frontera, J Rene" uniqKey="Frontera J" first="J Rene" last="Frontera">J Rene Frontera</name><affiliation wicri:level="2"><nlm:affiliation>Michigan Institute of Urology, Troy, Michigan.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea>Michigan Institute of Urology, Troy</wicri:cityArea></affiliation></author><author><name sortKey="Jafri, S Mohammad" sort="Jafri, S Mohammad" uniqKey="Jafri S" first="S Mohammad" last="Jafri">S Mohammad Jafri</name><affiliation wicri:level="2"><nlm:affiliation>William Beaumont Hospital, Royal Oak, Michigan.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea>William Beaumont Hospital, Royal Oak</wicri:cityArea></affiliation></author><author><name sortKey="Hollingsworth, John M" sort="Hollingsworth, John M" uniqKey="Hollingsworth J" first="John M" last="Hollingsworth">John M. Hollingsworth</name><affiliation wicri:level="2"><nlm:affiliation>Department of Urology, University of Michigan, Ann Arbor, Michigan.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea>Department of Urology, University of Michigan, Ann Arbor</wicri:cityArea></affiliation></author><author><name sortKey="Dauw, Casey A" sort="Dauw, Casey A" uniqKey="Dauw C" first="Casey A" last="Dauw">Casey A. Dauw</name><affiliation wicri:level="2"><nlm:affiliation>Department of Urology, University of Michigan, Ann Arbor, Michigan.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea>Department of Urology, University of Michigan, Ann Arbor</wicri:cityArea></affiliation></author><author><name sortKey="Ghani, Khurshid R" sort="Ghani, Khurshid R" uniqKey="Ghani K" first="Khurshid R" last="Ghani">Khurshid R. Ghani</name><affiliation wicri:level="2"><nlm:affiliation>Department of Urology, University of Michigan, Ann Arbor, Michigan.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea>Department of Urology, University of Michigan, Ann Arbor</wicri:cityArea></affiliation></author></analytic><series><title level="j">The Journal of urology</title><idno type="eISSN">1527-3792</idno><imprint><date when="2021" type="published">2021</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>PURPOSE</b></p><p>AUA guidelines recommend ureteroscopy as first line therapy for patients on anticoagulant or antiplatelet therapy and advocate using a ureteral access sheath. We examined practice patterns and unplanned health care use for these patients in Michigan.</p></div><div type="abstract" xml:lang="en"><p><b>MATERIALS AND METHODS</b></p><p>Using the Michigan Urological Surgery Improvement Collaborative (MUSIC) clinical registry we identified ureteroscopy cases from 2016 to 2019. We assessed outcomes and adherence to guidelines based on therapy at time of ureteroscopy: 1) anticoagulant: continuous warfarin or novel oral agent therapy; 2) antiplatelet: continuous clopidogrel or aspirin therapy; 3) control: not on anticoagulant/antiplatelet therapy. We fit multivariate models to assess anticoagulant or antiplatelet therapy association with emergency department visits, hospitalization and ureteral access sheath use.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>In total, 9,982 ureteroscopies were performed across 31 practices with 3.1% and 7.8% on anticoagulant and antiplatelet therapy, respectively. There were practice (0% to 21%) and surgeon (0% to 35%) variations in performing ureteroscopy on patients on anticoagulant/antiplatelet therapy regardless of volume. After adjusting for risk factors, anticoagulant or antiplatelet therapy was not associated with emergency department visits. Hospitalization rates in anticoagulant, antiplatelet and control groups were 4.3%, 5.5% and 3.2%, respectively, and significantly increased with antiplatelet therapy (OR 1.48, 95% CI 1.02-2.14). Practice-level ureteral access sheath use varied (23% to 100%) and was not associated with anticoagulant/antiplatelet therapy. Limitations include inability to risk stratify between type/dosage of anticoagulant/antiplatelet therapy.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>We found practice-level and surgeon-level variation in performing ureteroscopy while on anticoagulant/antiplatelet therapy. Ureteroscopy on anticoagulant is safe. However, antiplatelet therapy increases the risk of hospitalization. Despite guideline recommendations, ureteral access sheath use is not associated with anticoagulant/antiplatelet therapy.</p></div></front></TEI><pubmed><MedlineCitation Status="In-Data-Review" Owner="NLM"><PMID Version="1">33035142</PMID><DateRevised><Year>2021</Year><Month>02</Month><Day>09</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1527-3792</ISSN><JournalIssue CitedMedium="Internet"><Volume>205</Volume><Issue>3</Issue><PubDate><Year>2021</Year><Month>Mar</Month></PubDate></JournalIssue><Title>The Journal of urology</Title><ISOAbbreviation>J Urol</ISOAbbreviation></Journal><ArticleTitle>Ureteroscopy in Patients Taking Anticoagulant or Antiplatelet Therapy: Practice Patterns and Outcomes in a Surgical Collaborative.</ArticleTitle><Pagination><MedlinePgn>833-840</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1097/JU.0000000000001416</ELocationID><Abstract><AbstractText Label="PURPOSE" NlmCategory="OBJECTIVE">AUA guidelines recommend ureteroscopy as first line therapy for patients on anticoagulant or antiplatelet therapy and advocate using a ureteral access sheath. We examined practice patterns and unplanned health care use for these patients in Michigan.</AbstractText><AbstractText Label="MATERIALS AND METHODS" NlmCategory="METHODS">Using the Michigan Urological Surgery Improvement Collaborative (MUSIC) clinical registry we identified ureteroscopy cases from 2016 to 2019. We assessed outcomes and adherence to guidelines based on therapy at time of ureteroscopy: 1) anticoagulant: continuous warfarin or novel oral agent therapy; 2) antiplatelet: continuous clopidogrel or aspirin therapy; 3) control: not on anticoagulant/antiplatelet therapy. We fit multivariate models to assess anticoagulant or antiplatelet therapy association with emergency department visits, hospitalization and ureteral access sheath use.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">In total, 9,982 ureteroscopies were performed across 31 practices with 3.1% and 7.8% on anticoagulant and antiplatelet therapy, respectively. There were practice (0% to 21%) and surgeon (0% to 35%) variations in performing ureteroscopy on patients on anticoagulant/antiplatelet therapy regardless of volume. After adjusting for risk factors, anticoagulant or antiplatelet therapy was not associated with emergency department visits. Hospitalization rates in anticoagulant, antiplatelet and control groups were 4.3%, 5.5% and 3.2%, respectively, and significantly increased with antiplatelet therapy (OR 1.48, 95% CI 1.02-2.14). Practice-level ureteral access sheath use varied (23% to 100%) and was not associated with anticoagulant/antiplatelet therapy. Limitations include inability to risk stratify between type/dosage of anticoagulant/antiplatelet therapy.</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">We found practice-level and surgeon-level variation in performing ureteroscopy while on anticoagulant/antiplatelet therapy. Ureteroscopy on anticoagulant is safe. However, antiplatelet therapy increases the risk of hospitalization. Despite guideline recommendations, ureteral access sheath use is not associated with anticoagulant/antiplatelet therapy.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Hiller</LastName><ForeName>Spencer C</ForeName><Initials>SC</Initials><AffiliationInfo><Affiliation>Department of Urology, University of Michigan, Ann Arbor, Michigan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Qi</LastName><ForeName>Ji</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Department of Urology, University of Michigan, Ann Arbor, Michigan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Leavitt</LastName><ForeName>David</ForeName><Initials>D</Initials><AffiliationInfo><Affiliation>Department of Urology, Henry Ford Hospital, Detroit, Michigan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Frontera</LastName><ForeName>J Rene</ForeName><Initials>JR</Initials><AffiliationInfo><Affiliation>Michigan Institute of Urology, Troy, Michigan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Jafri</LastName><ForeName>S Mohammad</ForeName><Initials>SM</Initials><AffiliationInfo><Affiliation>William Beaumont Hospital, Royal Oak, Michigan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hollingsworth</LastName><ForeName>John M</ForeName><Initials>JM</Initials><AffiliationInfo><Affiliation>Department of Urology, University of Michigan, Ann Arbor, Michigan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Dauw</LastName><ForeName>Casey A</ForeName><Initials>CA</Initials><AffiliationInfo><Affiliation>Department of Urology, University of Michigan, Ann Arbor, Michigan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ghani</LastName><ForeName>Khurshid R</ForeName><Initials>KR</Initials><AffiliationInfo><Affiliation>Department of Urology, University of Michigan, Ann Arbor, Michigan.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>10</Month><Day>09</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>J Urol</MedlineTA><NlmUniqueID>0376374</NlmUniqueID><ISSNLinking>0022-5347</ISSNLinking></MedlineJournalInfo><CitationSubset>AIM</CitationSubset><CitationSubset>IM</CitationSubset><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">anticoagulants</Keyword><Keyword MajorTopicYN="N">guideline adherence</Keyword><Keyword MajorTopicYN="N">lithotripsy, laser</Keyword><Keyword MajorTopicYN="N">platelet aggregation inhibitors</Keyword><Keyword MajorTopicYN="N">ureteroscopy</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="pubmed"><Year>2020</Year><Month>10</Month><Day>10</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2020</Year><Month>10</Month><Day>10</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2020</Year><Month>10</Month><Day>9</Day><Hour>17</Hour><Minute>7</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">33035142</ArticleId><ArticleId IdType="doi">10.1097/JU.0000000000001416</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>États-Unis</li></country><region><li>Michigan</li></region></list><tree><country name="États-Unis"><region name="Michigan"><name sortKey="Hiller, Spencer C" sort="Hiller, Spencer C" uniqKey="Hiller S" first="Spencer C" last="Hiller">Spencer C. Hiller</name></region><name sortKey="Dauw, Casey A" sort="Dauw, Casey A" uniqKey="Dauw C" first="Casey A" last="Dauw">Casey A. Dauw</name><name sortKey="Frontera, J Rene" sort="Frontera, J Rene" uniqKey="Frontera J" first="J Rene" last="Frontera">J Rene Frontera</name><name sortKey="Ghani, Khurshid R" sort="Ghani, Khurshid R" uniqKey="Ghani K" first="Khurshid R" last="Ghani">Khurshid R. Ghani</name><name sortKey="Hollingsworth, John M" sort="Hollingsworth, John M" uniqKey="Hollingsworth J" first="John M" last="Hollingsworth">John M. Hollingsworth</name><name sortKey="Jafri, S Mohammad" sort="Jafri, S Mohammad" uniqKey="Jafri S" first="S Mohammad" last="Jafri">S Mohammad Jafri</name><name sortKey="Leavitt, David" sort="Leavitt, David" uniqKey="Leavitt D" first="David" last="Leavitt">David Leavitt</name><name sortKey="Qi, Ji" sort="Qi, Ji" uniqKey="Qi J" first="Ji" last="Qi">Ji Qi</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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