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N37 Macroscopic haematuria – a leading urological problem in patients on anticoagulant therapy. Is the common diagnostic standard still advisable?

      Introduction and Objectives

      The use of anticoagulant drugs (AcD) is a popular and beneficial therapy for patients with numerous diseases. However, serious complications may occur, i.e. bleeding in the form of haematuria (hmt). Hmt, as a symptom of serious urinary tracts diseases, should be an urgent diagnostic matter for a clinicist. Iatrogenic hmt may be the reason for urological consultation and hospitalization, during which expensive diagnostic procedures are performed. The aim was to assess the phenomenon of iatrogenic hmt in a current clinical practice and analyze its origins in patients receiving AcD. The economic aspects of diagnosing hmt were of special interest.

      Material and Methods

      Retrospective analysis of clinical documentation of 238 patients aged 18–99 years (mean 57 years) was performed. All patients were consulted for hmt in 2007–09 by 5 consultants-urologist in the following departments: nephrology (43), cardiology (27), general (23) and vascular surgery (11), cardiosurgery (40), hematology (34), gynecology (11) and internal diseases (49). In the group of 238 patients with hmt, there were 155 (65%) men, who received AcD – group A: oral anticoagulants (36%), non- or fractionized heparins (27%) and antiplatelet drugs: acetylsalicylic acid (21%), clopidogrel (11%), ticlopidine (5%). Another 83 patients, who presented with hmt – group B, did not receive any AcD. Hmt was found mainly in patients >65 years (67%), with concomitant diseases (71%): HT, CHD, arrythmia, end-stage renal disease. The majority of patients had the full diagnostic panel performed (n = 216, 91%) including: USG of urinary tracts, urography or contrast-CT and cystoscopy. The diagnostic results were analyzed with the special attention to the negative ones, in which no patologies in urinary tracts were found (n = 193, 81%).

      Results

      Pathologies of urinary tract were found in 45 (19%) patients: neoplasms – bladder cancer (8), prostate cancer (6), renal cancer (4), urothelial cancer of upper urinary tract (3); inflammatory conditions (5); benign prostate hyperplasia (12); urolithiasis (7). The number of pathologies detected in the group A compared with group B was 8% and 16%, respectively (p = 0.2). Estimated cost of diagnostic procedures for hmt per patient was 333 EUR, assuming average time of diagnostics as a 3-day hospitalization. The cost-effectiveness analysis revealed that the cost of a single neoplasm detection reaches the unacceptable value of 3777 EUR.

      Conclusions

      In our study, the significant correlation between the presence of hmt and anticoagulant therapy was observed. Urological origins of hmt are more often present in patients not receiving AcD. Standard diagnostic procedure, as a expensive and invasive action, should be engaged only after critical analysis of potential influence of AcD on the presence of hmt. Further studies on this topic would be beneficial for clinicists and health care providers.