Outcomes of retrograde intrarenal surgery in patients on anticoagulant or antiplatelet therapy: a multicenter matched case-control study by the RIRSearch Study Group

Purpose This study aimed to assess the outcomes of various perioperative management strategies employed during retrograde intrarenal surgery (RIRS) in patients receiving anticoagulant (AC) or antiplatelet (AP) therapy. Methods In this multicenter retrospective matched case–control study, we included patients with nephrolithiasis who received AC or AP therapy and underwent RIRS. The control group consisted of patients not receiving AC/AP therapy. Group 1 included patients who discontinued AC/AP treatment prior to RIRS, whereas Group 2 comprised patients who also discontinued AC/AP therapy but received bridging anticoagulation. The primary endpoints were surgical success and RIRS-related complications. These outcomes were assessed using non-contrast abdominopelvic computed tomography (CT) scans obtained during the first postoperative month. Results In the final analysis, Group 1 and Group 2 each comprised 50 patients, while the control group consisted of 56 patients. The mean age was 59.36 ± 8.86 years in Group 1, 59.96 ± 9.70 years in Group 2, and 56.59 ± 11.56 years in the control group (p = 0.452). Surgical success was significantly lower in Group 2 (p = 0.026), and the need for auxiliary procedures was significantly higher in this group (p = 0.009). Although perioperative complications tended to be higher in Group 2 (p = 0.053), no statistically significant differences were observed in postoperative or overall complication rates. Conclusions Patients undergoing RIRS with bridging anticoagulation demonstrated lower surgical success rates and a higher need for auxiliary procedures. These findings underscore the importance of close monitoring and individualized perioperative management in this high-risk patient population.