Gross haematuria in the era of anticoagulant therapy - Implications on treatment and diagnostic approaches in a large emergency department patient population.

Introduction: Treatment with anticoagulants or antiplatelet drugs can provoke gross haematuria. In some cases, this may demask urologic malignancies. The goal of this study was to determine the influence of anticoagulants and antiplatelet drugs on the diagnosis and therapy of patients with gross haematuria who presented in the emergency department.

Methods: This retrospective study analysed patients presenting with gross haematuria between January 1st, 2021 and December 31st, 2021 in a single centre university hospital. Information on pre-existing conditions, anticoagulant and antiplatelet medication, and the further diagnostic and treatment course was gathered with a follow-up time until December 31st, 2022.

Results: Nearly half of the 541 patients (49.5%) presenting with gross haematuria were taking anticoagulant or antiplatelet medication. Patients receiving these medications were more likely to need bladder irrigation (p < 0.001). They were also more likely to be hospitalized (p < 0.001) and receive operative intervention (p = 0.011). The most common cause for haematuria was malignant tumours. A malignant urologic disease was diagnosed in 27% of the patients. Among those who were diagnosed with a malignant disease, the number of patients taking anticoagulant medication was higher (p = 0.005). In a follow-up of 3 months, no thromboembolic events were observed after stopping or pausing anticoagulation or antiplatelet treatment.

Conclusion: Clinically significant gross haematuria is often associated with the intake of anticoagulant or antiplatelet medication and can unmask underlying malignant diseases. The intake of anticoagulation or antiplatelet therapy should not be a reason to postpone diagnostic and therapeutic measures.