Antithrombotics Associated with Gross Hematuria

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

Antithrombotic drugs are associated with significantly increased risks for complications related to gross hematuria, according to a retrospective study in JAMA.

Using Ontario healthcare databases, researchers studied 2.5 million adults aged 66 and older without cancer who were actively receiving medical care in the province between 2002 and 2014. About a third received first prescriptions for antiplatelets or anticoagulants during the study period.

Over roughly 7 years' follow-up, rates of complications related to gross hematuria — including hospitalizations, emergency department visits, and urologic interventions — were significantly higher during periods of antithrombotic exposure versus unexposed periods (124 vs. 80 events per 1000 person-years). The increased risk was highest for emergency department visits (rate ratio, 2.8). Complications were more common with anticoagulants than antiplatelets; aspirin had the lowest complication rate.

Patients taking antithrombotics were also more likely to be diagnosed with bladder cancer, but the researchers say that antithrombotic use "was likely unmasking otherwise clinically silent bladder cancers."