Presentation Authors: Abdulaziz Alathel*, Riyadh, Saudi Arabia
Introduction: The use of new/novel oral anticoagulants (NOACs) continues to increase and Urologists are faced with increasing numbers of patients in their practice using these agents. Although general guidelines directing the management of these medications in the perioperative period exist for open and endoscopic procedures, no consensus exists for those patients being considered for shock wave lithotripsy (SWL). In order to gauge current practice, we developed and sent a survey to the endourological community.
Methods: A web-based survey was sent to all current Endourological Society members. Members were asked 10 questions regarding their current practice in dealing with patients using NOACs and who might be candidates for SWL. Respondents were specifically asked whether being on a NOAC would be considered a contraindication to SWL, or if SWL was to be performed, when the agent would be discontinued preoperatively and resumed postoperatively. Respondents were also queried on who managed the NOAC discontinuation and resumption.
Results: There were 165 respondents from 37 countries, with the largest cohort responding from North America (43%). (87.8%) of society members had been in practice for 5 years or more, with (70%) being in an academic practice. The vast majority (92.73%) provided SWL treatments in their institutions, while only (53.37%) would consider offering SWL to patients taking NOACs. The decision on when to stop NOACs prior to SWL, was made by (36.65%) of urologists although the majority (56%) consulted internal medicine/cardiology for their input. The majority of urologists (64.2%) handled the resumption of the NOACs after SWL by themselves. There appeared to be great variability in the number of days prior to SWL were NOACs stopped, and when they were resumed Post treatment.
Conclusions: Somewhat surprisingly, over half of surveyed endourologists do not even offer SWL to patients taking NOACs. For those patients who are treated with SWL there appears to be a lack of consensus among endourologists on what is the optimal duration of NOAC cessation, suggesting a need to establish evidence-based guidance to optimize outcomes.