The effect of oral anticoagulation on the prevalence and management of haematuria in a contemporary Australian patient cohort

Abstract

What ' s known on the subject? and What does the study add? Urologists are increasingly involved in the management of patients taking oral anticoagulation ( OA ) who present with haematuria. It is accepted practice that haematuria in the presence of concurrent anticoagulation requires a full diagnostic evaluation, as it is frequently precipitated by a signifi cant pathological lesion. However, there is limited data on the impact of anticoagulation on the initial inpatient management of these patients. Much of the current evidence is either based around perioperative management of elective patients or, for emergency presentations, is focused on bleeding associated with high morbidity and mortality, such as in the neurosurgical population.In the present study, about half of all admissions with haematuria were for patients on some form of OA . The use of OA strongly predicted for the need for admission for bladder irrigation, regardless of the type of agent or combination of agents used. The use of dual antiplatelet therapy had the strongest association with the need for bladder irrigation, probably due to the well-described synergistic effect between aspirin and clopidogrel. The results of the present study emphasise the importance of early intervention in the management of patients on OA presenting with haematuria. Objective• To examine the effect of oral anticoagulation ( OA ) on the prevalence and inpatient management of haematuria in a contemporary Australian patient cohort. Patients and methods• Patients across all inpatient units who had diagnosis-related group ( DRG ) coding for haematuria were identifi ed from April 2010 to September 2011.• A retrospective chart review was performed to identify the type of anticoagulation (if any), requirement for bladder irrigation or blood transfusion, length of stay ( LOS ) and cause of haematuria.• Patients for whom the anticoagulation status was uncertain were excluded from analysis.• Statistical signifi cance was determined by Pearson ' s chi-square tests and Student ' s t -tests. Results• In all, 335 admissions with DRG coding for haematuria were identifi ed from hospital records, of which 268 admissions had clear documentation of anticoagulation. There were 118 emergency admissions and 150 elective admissions for day case cystoscopy. The mean age of the patients was 66 years and the male:female ratio was 5:1. In all, 123 admissions were for patients on some form of anticoagulation (46%).• Patients were on anticoagulation in 53% of the 118 emergency admissions for gross haematuria. These comprised patients on aspirin (28%), clopidogrel (4%), warfarin (10%), combined aspirin and warfarin (1%) and combined aspirin and clopidogrel (10%).• The use of OA was a signifi cant predictor of the need for intervention among the 118 emergency admissions (86% vs 62%, P = 0.003).• In particular, dual antiplatelet therapy in the form of aspirin and clopidogrel was associated with an increased requirement for bladder irrigation (92%) when compared with patients on other forms of ant...

Anticoagulant‐related hospital admissions: serious adverse reactions identified through hospital databases

“…For the other hospital admissions highlighted only by the ‘Y44.2’ code that does not refer to any dosage, nothing can be deducted because adverse effects can occur within normal therapeutic usage. It should also be noted that a growing number of patients today receive dual antithrombotic therapy that exposes patients to a higher risk of adverse reactions …”

“…Anticoagulant therapies are effective for the prevention and treatment of thromboembolic events. Guidelines on the use of anticoagulants have been established . Over the past 10 years, the number of patients receiving oral anticoagulant therapy increased primarily because of the greater number of elderly patients with chronic AF, patients for whom this therapy is initiated to prevent stroke.…”

Differenzialdiagnose der Hämaturie

“…In einer 2012 veröffentlichen australischen Studie in der urologischen Grundversorgung wurde gezeigt, dass von 268 Hämaturiepa-Jeder Infekt der Harnwege kann zu einer Hämaturie führen Ab dem 40. Lebensjahr steigt der Anteil der Patienten, bei denen ein malignes urologisches Leiden Ursache der Hämaturie ist CME tienten in der Altersgruppe über 60 Jahre 123 (46%) unter irgendeiner Form der oralen Antikoagulation standen [13]. Zwar gilt gemeinhin die Antikoagulation nicht als Ursache der Hämaturie [3], sodass eine weitere Ursachenabklärung indiziert bleibt, doch kann durch sie die Hämaturie verschärft werden.…”

“…Zwar gilt gemeinhin die Antikoagulation nicht als Ursache der Hämaturie [3], sodass eine weitere Ursachenabklärung indiziert bleibt, doch kann durch sie die Hämaturie verschärft werden. Dies bestätigte die australische Hämaturiestudie, in der im Vergleich zu anderen Antikoagulationsformen gerade die doppelte Plättchenaggregationshemmung mit Clopidogrel und Acetylsalicylsäure am häufigsten die Notwendigkeit einer Blasenspülung nach sich zog (92%) [13]. In dieser Studie war die BPH mit 21%, gefolgt von Blasenkarzinomen, der häufigste Grund für die Hämaturie.…”

Developing a Diagnostic Multivariable Prediction Model for Urinary Tract Cancer in Patients Referred with Haematuria: Results from the IDENTIFY Collaborative Study

“…Four wellestablished risk markers were used to predict bladder cancer (type of haematuria, age, sex, and smoking history) [7,[10][11][12][13]. However, the model neither predicted upper tract cancer nor included other important clinical risk markers such as anticoagulation, previous radiotherapy, and urinary tract infections, which have been described in the literature [14][15][16].…”