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Antithrombotic Use and Hematuria Complications
Study Questions:
What is the rate of hematuria-related complications among patients taking antithrombotic medications?
Methods:
Using a population-based, retrospective cohort study of Ontario, Canada, patients age ≥66 years were studied between 2002 and 2014. Patients who received an oral anticoagulant or antiplatelet medication were evaluated for hematuria-related complications, including emergency department (ED) visits, hospitalization, or a urologic procedure to investigate or manage hematuria.
Results:
During the study, 808,897 patients (mean age 72.1, 53% women) received at least one prescription for an antithrombotic agent. Over a median follow-up of 7.3 years, the rates of hematuria-related complications were 123.95 events per 1,000 person-years exposed to antithrombotic agents vs. 80.17 events per 1,000 patient-years for nonexposed patients (difference, 43.8; 95% confidence interval [CI], 43.0-44.6; p < 0.001). Compared with patients unexposed to antithrombotic agents, the rate of hematuria-related complications was highest among patients on both anticoagulants and antiplatelets (191.61 events per 1,000 person-years), followed by patients on anticoagulants (140.92 events per 1,000 person-years), and patients on antiplatelets (110.72 events per 1,000 person-years).
Conclusions:
The authors concluded that among older adults in Ontario, Canada, the use of antithrombotic medications was associated with an increased rate of hematuria-related complications.
Perspective:
Hematuria is one of the most common complaints among patients taking chronic antithrombotic medications. While not as life-threatening as other forms of bleeding (e.g., intracranial hemorrhage), it is quite distressing to patients and a challenge for many providers to manage. This study quantifies the risk of hematuria-related complications for patients on various antithrombotic agents. Not surprisingly, patients on combined anticoagulants and antiplatelets are at highest risk, followed by anticoagulants and then antiplatelet medications. Therefore, clinicians should try to minimize the number of antithrombotic agents that a patient is taking without jeopardizing thrombotic risk.
Keywords: Anticoagulants, Emergency Service, Hospital, Fibrinolytic Agents, Hematuria, Hemorrhage, Intracranial Hemorrhages, Platelet Aggregation Inhibitors, Primary Prevention, Thrombosis, Urologic Diseases, Vascular Diseases
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