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 retro-grade 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 proce-dures 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 periopera-tive management in this high-risk patient population.