Studies on Changes in Parameters of the Coagulation and Fibrinolysis in Association with Extracorporeal Shock Wave Lithotripsy

Abstract

Tissue damage by extracorporeal shock wave lithotripsy (ESWL) is assumed to be attributable to ischemic changes in the treated region surrounding the particular vessel which is first ruptured by shock waves. Such changes cannot take place without being accompanied by acceleration of coagulation and fibrinolysis. In the literature on renal damage by ESWL, no parameters of the coagulation and fibrinolysis of blood were used. The present study was designed to investigate renal damage by shock waves through the quantification of sequential changes in the following parameters between before and after ESWL: thrombin antithrombin III complex (TAT), α₂-plasmin inhibitorplasmin complex (PIC), fibrin and fibrinogen degradation products (FDP) and D-dimer (D-D). In ESWL for renal stones, a significant acceleration of TAT occurred on the 1 st postoperative day, followed by acceleration of PIC on the 3rd postoperative day. A transient acceleration was observed for FDP and D-D after operation. The levels of these parameters, however, returned to normal by the 1st postoperative week. In ESWL for ureteral stones, unlike for renal stones, none of the parameters showed statistically significant acceleration. In the construction of percutaneous nephrostomy (PNS) cases for ureteral stones before ESWL, none of the parameters showed significant acceleration either. Changes in these parameters of coagulation and fibrinolysis due to ESWL for renal stones were greater than those of construction of PNS or ESWL for ureteral stones. The reason for the difference of the alteration in these parameters between renal stones and ureteral stones were more abundant vessels in the kidney than the ureter. All these changes in the parameters, however, disappeared within almost 1 week.

Evaluation of hemostasis parameters and the role of the oxidative damage to plasma proteins in the modulation of hemostasis in patients with nephrolithiasis before and after extracorporeal shock wave lithotripsy

“…D-dimer concentration, in nephrolithiasis patients following ESWL, compared to healthy subjects and patients undergoing ESWL. These observations were similar to those of Umekawa et al [ 2 ] and Hughes et al [ 3 ]. Umekawa et al [ 2 ] report a correlation between fibrin degradation products (FDP) and D-dimer concentration following SWL.…”

“…These observations were similar to those of Umekawa et al [ 2 ] and Hughes et al [ 3 ]. Umekawa et al [ 2 ] report a correlation between fibrin degradation products (FDP) and D-dimer concentration following SWL. Interestingly, our present findings do not include any significant changes in PT, TT or APTT in patients with nephrolithiasis, either before or after ESWL.…”

“…A few papers indicate that patients with nephrolithiasis are at increased risk of hemostatic complications, especially increased risk of coagulopathy, following SWL [ 2 , 3 ]. However, the pathogenesis of hemostasis in patients with nephrolithiasis, particularly after forms of treatment such as SWL, is not completely understood.…”

“…Blood platelets are also very important element of hemostasis. Some papers note the presence of various hemostatic complications are observed in patients with nephrolithiasis after extracorporeal shock wave lithotripsy (ESWL) [ 2 , 3 ]. Moreover, other complications associated with ESWL (i.e.…”

A Pilot Study to Evaluate Haemostatic Function, following Shock Wave Lithotripsy (SWL) for the Treatment of Solitary Kidney Stones

“…Measurement of D-dimer, which is a marker of haemostatic activity, showed a significant increase in concentration following SWL (p = 0.019). These observations were similar to those of Umekawa et al (1993), who reported a transient acceleration in fibrin degradation products (FDP) and D-dimer levels following SWL [ 20 ]. Interestingly, no significant changes were observed in the PT and aPTT following SWL, although fibrinogen concentration decreased significantly (p = 0.014).…”