Clinical Significance of Hematuria in Atrial Fibrillation With Oral Anticoagulation Therapy

Abstract

Background: Hematuria is a common and important complication in atrial fibrillation (AF) patients on oral anticoagulation therapy (OAT). This study evaluated the clinical significance of hematuria and its relationship with genitourinary disease in AF patients receiving OAT. Methods and Results:Among 20,456 consecutive AF patients who visited a tertiary hospital from January 2005 to April 2015, 5,833 had hematuria. Of these 5,833 patients, 3,798 were on OAT (OAT(+) group) and 2,035 were not (OAT(-) group). A total of 1,785 patients from each group were then matched on propensity score analysis. The prevalence of cancer and other diseases in the genitourinary tract was evaluated. While there was no difference in the prevalence of genitourinary stones or urinary tract infection, genitourinary cancer was significantly more common in the OAT(+) group than in the OAT(-) group (1.6% vs. 0.7%, P=0.011). Bladder cancer was the most common genitourinary malignancy, and it was significantly more common in the OAT(+) group (1.2% vs. 0.5%, P=0.019). Subjects on warfarin were more likely to have bladder cancers of lower pathologic grade (63.6% vs. 33.3%, P=0.124). Conclusions:OAT was associated with a higher prevalence and early detection of genitourinary cancer in AF patients with hematuria. Meticulous evaluation of the cause of hematuria is necessary in AF patients with hematuria receiving OAT.

Genitourinary Hemorrhagic Complications and Malignancies in Patients Receiving Anticoagulation Therapy

“…The authors also state that being on OAT can detect preexisting occult genitourinary cancer earlier, especially bladder cancer. 2 Indeed, the pathological grade of bladder cancer detected in patients with OAT was lower than that in those who were not, indicating that OAT had helped to detect the cancer earlier. 2 Second, another consideration is whether an anticoagulant itself influences the incidence of genitourinary cancer.…”

“…2 Indeed, the pathological grade of bladder cancer detected in patients with OAT was lower than that in those who were not, indicating that OAT had helped to detect the cancer earlier. 2 Second, another consideration is whether an anticoagulant itself influences the incidence of genitourinary cancer. A few years ago, Lewis et al reported from the Kaiser Permanente Northern California diabetes registry that the…”

“…In addition, warfarin was the sole anticoagulant in that study. 2 The influence of non-vitamin K antagonist oral anticoagulants (NOACs or direct oral anticoagulants [DOACs]) on genitourinary bleeding may be different from that of warfarin as for gastrointestinal bleeding. Additional studies using NOACs are expected in the future.…”

“…The odds ratio for genitourinary cancers in patients with urine RBC grade 3+ and gross hematuria was significantly higher compared with patients with urine RBC grade 1+ ( Figure 1A). 2 …”

Management of bleeding in patients hospitalized in the intensive cardiac care unit: expert opinion of the Association of Intensive Cardiac Care and Section of Cardiovascular Pharmacotherapy of the Polish Cardiac Society in cooperation with specialists in other fields of medicine

“…About 19% to 25% of these individuals present with different types of cancer, 7 7,78 the most common being bladder cancer. 79 According to a consultant urologist at the Institute of Cardiology in Warsaw, Poland, almost half of the consultations are due to hematuria.…”