Objective
To determine the probability of visible hematuria with antithrombotic agents and to
evaluate association of urologic etiology in antithrombotic-related hematuria.
Methods
Preferred Reporting Items in Systematic Reviews and Meta-Analyses guidelines were
followed to conduct a systematic review using search engines PUBMED and SCOPUS with
the terms “(hematuria) OR (haematuria) OR urinary bleeding)) AND ((anticoagulants)
OR anticoagulation) OR noac) OR novel anticoagulants) OR antiplatelet) OR dabigatran)
OR rivaroxaban) OR apixaban) OR warfarin) OR aspirin) OR heparin) OR dipyridamole).”
Raw data were used to perform a pooled analysis. Chi-square and logistic regression
analysis were used for statistical analyses.
Results
Twenty-two studies describing 175,114 patients met inclusion criteria. Odds ratio
of hematuria with warfarin to rivoraxaban was 33 and warfarin to dabigatran was 16.
The odds ratio of hematuria for oral anticoagulant (26.7%) to prophylactic parenteral
anticoagulant (1.1%) agents was 9.6. Antiplatelet agents are 76 times less likely
to cause hematuria compared to anticoagulants. Odds of hematuria with aspirin were
6.7 times the odds with clopidogrel and 3.5 times the odds with ticagrelor. Dabigatran
was 198 times more likely to cause major hematuria compared to warfarin, whereas clopidogrel
is 1.2 times more likely to cause major hematuria compared to aspirin. Urologic pathology
was identified in 44% (234/532) of cases, malignancy in 24%.
Conclusion
Warfarin use poses the greatest risk for hematuria but is unlikely to cause major
hematuria, whereas novel antithrombotic agents are more commonly associated with major
hematuria. This review further characterizes the risk profile of antithrombotic agents
and associated hematuria to equip clinicians with knowledge to choose an appropriate
antithrombotic agent in patients with high-risk hematuria.
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Article info
Publication history
Published online: November 27, 2017
Accepted:
November 15,
2017
Received:
September 25,
2017
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
