Kidney Stone Disease in Patients on Antithrombotic Therapy That Cannot Be Discontinued
Managing kidney stones becomes significantly more complex when a patient is on antithrombotic therapy and stopping it carries a high risk of thrombotic complications. In this scenario, standard surgical approaches must be reconsidered to minimise bleeding risk while still addressing the stone.
Clinical Scenario
The patient is on antithrombotic therapy that cannot be discontinued due to a high risk of thrombotic complications. This constraint directly shapes the choice of intervention — procedures associated with greater bleeding risk must be avoided or deferred.
Treatment Approach
When stone removal is essential in this setting, a specific endoscopic approach is preferred because of its more favourable morbidity profile compared with alternatives that carry higher bleeding risk.
Full selection criteria, procedural details, and decision pathway available in the complete protocol →
References
If a patient cannot interrupt antithrombotic therapy, PCNL should be delayed or ureteroscopy can be performed as the first-line alternative for stone intervention if suitable.
Retrograde (flexible) URS is the preferred intervention if stone removal is essential and antithrombotic therapy cannot be discontinued since it is associated with less morbidity.
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