The Safety of Continuing Low-Dose Aspirin Therapy Perioperatively in Percutaneous Nephrolithotomy: A Systematic Review and Meta-analysis

Purpose: Aspirin is often stopped prior to percutaneous nephrolithotomy (PCNL) due to surgical bleeding risk. However, this practice is mainly based on expert opinion, and mounting evidence suggests holding aspirin perioperatively might not be more harmful than once thought. In this systematic review and meta-analysis, we aimed to discuss the safety of continuing low-dose aspirin perioperatively in PCNL. Materials and Method: We performed a comprehensive literature search in PubMed, EMBASE, Web of Science, and Cochrane Library to identify relevant studies up to December 31st, 2021. The ROBINS-I (Risk of Bias in Non-randomized Studies of Interventions) tool was used to evaluate the quality of the included studies. The safety was assessed by all kinds of perioperative complications and bleeding complications mainly. Egger's test estimated publication bias. The statistical analyses were performed using Rev-Man 5.3 and STATA 15.1 software. Results: Overall, four eligible studies with a total of 1054 patients were included in our study. The meta-analysis results revealed that operative time (95%CI: -14.20 - 4.50, MD=-4.85, P=.31), hospital durations (95%CI: -1.80 - 0.50, MD=-0.65, P=.26), stone size (95%CI: -2.90 - 0.67, MD=-1.11, P=.22), and estimated blood loss (95%CI: -17.15 - 0.47, MD=-8.34, P=.06) were not significantly different between the continuing low-dose aspirin group and the control group. Moreover, there were no significant differences in total complication rate (25% vs 27.9%, 95%CI: -0.07 - 0.08, RD=0.00, P=.94) and serious complication rate (6.0% vs 3.0%, 95%CI: -0.08 - 0.06, RD=-0.01, P=.84) between the two groups. Similarly, no significant differences were observed in terms of bleeding complication rate (8.3% vs 14.0%, 95%CI: -0.04 - 0.06, RD=0.01, P=.75), transfusion rate (5.4% vs 10.8%, 95%CI: -0.04 - 0.04, RD=-0.00, P=.98), and postoperative thrombotic events rate (0.6% vs 0.2%, 95%CI: -0.03 - 0.02, RD=-0.00, P=.85). Sensitivity analysis suggested that our results were convincing and no publication bias was observed with the Egger's test (P=.112). Conclusion: It appears that continuing low-dose aspirin therapy perioperatively in PCNL might be relatively safe. However, further well-designed prospective studies with a large sample size are needed to confirm and validate our findings.