Gross Hematuria Associated with Anticoagulants and Antiplatelet Drugs: Analysis of Current Treatment Standards and Relevance of Co-medication and Pharmacological Interactions

Laura Lawaczeck; Raika Slomma; Arnulf Stenzl; Stefan Aufderklamm; Valentina Norz; Joël Hammes; Hans-Peter Lipp; Steffen Rausch

doi:10.1016/j.euf.2023.09.004

Gross Hematuria Associated with Anticoagulants and Antiplatelet Drugs: Analysis of Current Treatment Standards and Relevance of Co-medication and Pharmacological Interactions

Eur Urol Focus. 2023 Sep 26:S2405-4569(23)00202-X. doi: 10.1016/j.euf.2023.09.004. Online ahead of print.

Authors

Laura Lawaczeck¹, Raika Slomma¹, Arnulf Stenzl¹, Stefan Aufderklamm¹, Valentina Norz¹, Joël Hammes¹, Hans-Peter Lipp², Steffen Rausch³

Affiliations

¹ Department of Urology, Eberhard-Karls-University, Tübingen, Germany.
² Department of Pharmacology, Eberhard-Karls-University, Tübingen, Germany.
³ Department of Urology, Eberhard-Karls-University, Tübingen, Germany. Electronic address: steffen.rausch@med.uni-tuebingen.de.

PMID: 37770373
DOI: 10.1016/j.euf.2023.09.004

Abstract

Background: Anticoagulants and antiplatelet drugs are risk factors for gross hematuria (GH). Moreover, co-medication and drug-drug interactions (DDIs) may influence GH and its clinical course.

Objective: To investigate the relationship between GH and administration of oral anticoagulants and antiplatelet drugs.

Design, setting, and participants: Hospitalized patients with GH in an academic tertiary reference center were included. The use of individual compounds and DDIs were recorded and correlated to relevant clinical outcome factors.

Outcome measurements and statistical analysis: The association between GH, DDIs, and clinical outcome parameters was analyzed using χ² and Kruskal-Wallis tests. DDIs were systematically evaluated using a previously published calculator.

Results and limitations: A total of 189 patients with GH were eligible for the study. Of these, 76.2% took anticoagulants or antiplatelet drugs. The mean hospitalization duration was 4.7 d. The mean bladder irrigation duration was 3.1 d and the mean volume of irrigation fluid used was 22.8 l. Overall, 30.7% of patients had a pre-existing genitourinary malignancy. DDIs were observed in 31.9% of cases. The irrigation duration (p = 0.01) and volume of irrigation fluid (p = 0.05) were significantly associated with the use of anticoagulants or antiplatelet drugs. Specific DDI patterns were not predictive of clinical outcome.

Conclusions: Medication with anticoagulants or antiplatelet drugs has a significant impact on GH and its clinical course. DDIs are a relevant issue and may lead to adverse clinical events or greater drug toxicity. Critical evaluation of medication and interdisciplinary counseling for patients with GH and urinary tract disease are recommended.

Patient summary: Drugs taken to reduce the risk of blood clotting can increase the risk of blood in the urine (called hematuria) and medical expenses for treatment. Drug-drug interactions are a relevant issue, especially in elderly patients and those with other medical conditions who are taking several drugs. Thoughtful discussion of individual risk profiles for hematuria and medication is therefore recommended.

Keywords: Anticoagulant; Bladder; Bleeding; Hematuria; Irrigation.