Hematuria in anticoagulated patients with atrial fibrillation and urologic cancer. Issue 1 (13th January 2022)

• Record Type: Journal Article
• Authors: Ording, Anne Gulbech; Søgaard, Mette; Skjøth, Flemming; Grove, Erik Lerkevang; Lip, Gregory Y. H.; Larsen, Torben Bjerregaard; Nielsen, Peter Brønnum
• Is Part Of: Research and practice in thrombosis and haemostasis. Volume 6:Issue 1(2022)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2022-01-13
• Subjects: anticoagulants -- atrial fibrillation -- hematuria -- urologic neoplasms -- warfarin; Thrombosis -- Periodicals; Hemostasis -- Periodicals; 616.135005
• DOI: 10.1002/rth2.12629
• Languages: English
• ISSNs: 2475-0379

Abstract

Abstract: Background: Based on their renal excretion, direct oral anticoagulants (DOACs) may increase the risk of hematuria in patients with atrial fibrillation (AF) and urologic cancer compared with vitamin K antagonists. Objectives: To examine the risk of bleeding associated with DOAC versus warfarin in patients with AF and urologic cancer. Methods: We conducted a Danish nationwide cohort study with individually linked registry data on patients with AF and active or a history of urologic cancer. We calculated crude rates per 100 person‐years of hospital episodes of major bleeding and hematuria. We then compared rates of hematuria during the year after initial oral anticoagulation filled prescription by treatment regimen using inverse probability of treatment weighting and Cox regression. Results: The study population included 2615 patients with AF and urologic cancer (6.1% women; median age, 76 years) initiating a DOAC or warfarin. One‐year risk of hematuria was 4.8% in the DOAC group and 4.7% in the warfarin group with a corresponding weighted hazard ratio (HR) of 1.21 (95% confidence interval [CI], 0.81‐1.81). HRs for hematuria were generally similar in analyses restricted to patients treated with standard‐dose DOAC and patients with active cancer. For those with cancer of the kidney, renal pelvis, ureter, and bladder, the HR was 0.82 (95% CI, 0.44‐1.54). Results were mirrored for other bleeding events, whereas the risk for intracranial bleeding was lower with DOACs. Conclusion: In patients with AF and urologic cancer, there was a similar risk of hematuria associated with DOAC and warfarin treatment.