BACKGROUND: Anticoagulant and antiplatelet medications are commonly prescribed and associated with urologic bleeding. Our objective was to evaluate the association of anticoagulant and antiplatelet medications with hematuria-related complications. Our hypothesis was that rivaroxaban has a higher risk of bleeding complications compared to other anticoagulant and antiplatelet medications.
METHODS: Individuals prescribed anticoagulant and/or antiplatelet medications between October 2015 and May 2021 at our institution were included. Baseline demographics were collected. Hematuria-related complications, defined as either emergency department visits for gross hematuria, hospital admissions for gross hematuria, or urologic procedures to manage gross hematuria were then measured using incidence density rates and a negative binomial regression model.
RESULTS: Of the 119,528 patients included, 10,601 (8.9%) were exposed to rivaroxaban and 108,927 (91.1%) were exposed to non-rivaroxaban anticoagulant/antiplatelet medications. Those unexposed to rivaroxaban had lower rates of any hematuria-related complications (adjusted rate ratio (aRR) 0.72; 95% confidence interval (CI) 0.65 to 0.79), had fewer hospitalizations (aRR 0.77; 95% CI 0.64 to 0.93) and required fewer urologic procedures to manage gross hematuria (aRR 0.54; 95% CI 0.47 to 0.64) compared to those exposed to rivaroxaban. Compared to rivaroxaban, enoxaparin had the highest rate of any hematuria-related complications (aRR 2.74; 95% CI 2.43 to 3.10).
CONCLUSIONS: Enoxaparin was associated with the greatest risk of hematuria-related complications. Among oral antiplatelet and anticoagulant medications, exposure to rivaroxaban was significantly associated with higher rates of hematuria-related complications, including hospitalization and the need for urologic procedures to manage gross hematuria.
