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Association Between Use of Antithrombotic Medication and Hematuria-Related Complications
Christopher J D Wallis1,2, Tristan Juvet1, Yuna Lee3
1Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Insights
Antithrombotic medications significantly increase the risk of hematuria-related complications in older adults. This includes higher rates of emergency department visits, hospitalizations, and urologic procedures for gross hematuria.
Area of Science:
- Geriatric Medicine
- Pharmacology
- Urology
Background:
- Antithrombotic medications are widely prescribed for preventing thrombotic events.
- Hematuria is a potential complication, necessitating further understanding of associated risks in older populations.
Purpose of the Study:
- To investigate the association between antithrombotic medication use and hematuria-related complications in older adults.
- To quantify the incidence rates of these complications in relation to antithrombotic exposure.
Main Methods:
- A population-based, retrospective cohort study was conducted in Ontario, Canada.
- Included were citizens aged 66 years and older from 2002 to 2014, analyzing receipt of oral anticoagulants or antiplatelet agents.
- Hematuria-related complications were defined as emergency department visits, hospitalizations, or urologic procedures for gross hematuria.
Main Results:
- The study analyzed 2,518,064 patients, with 808,897 exposed to antithrombotic agents.
- Patients on antithrombotics had a significantly higher rate of hematuria-related complications (123.95 events/1000 person-years) compared to unexposed patients (80.17 events/1000 person-years).
- Higher complication rates were observed for urologic procedures, hospitalizations, and emergency department visits in the exposed group. Those on both anticoagulant and antiplatelet agents showed the highest risk (191.61 events/1000 person-years).
Conclusions:
- Use of antithrombotic medications in older adults is associated with a significantly increased risk of hematuria-related complications.
- These findings highlight the importance of monitoring for hematuria in elderly patients prescribed antithrombotic therapy.
- The study suggests a potential link between antithrombotic use and subsequent bladder cancer diagnosis.
Importance:
Antithrombotic medications are among the most commonly prescribed medications.
Objective:
To characterize rates of hematuria-related complications among patients taking antithrombotic medications.
Design, Setting, And Participants:
Population-based, retrospective cohort study including all citizens in Ontario, Canada, aged 66 years and older between 2002 and 2014. The final follow-up date was December 31, 2014.
Exposures:
Receipt of an oral anticoagulant or antiplatelet medication.
Main Outcomes And Measures:
Hematuria-related complications, defined as emergency department visit, hospitalization, or a urologic procedure to investigate or manage gross hematuria.
Results:
Among 2 518 064 patients, 808 897 (mean [SD] age, 72.1 [6.8] years; 428 531 [53%] women) received at least 1 prescription for an antithrombotic agent over the study period. Over a median follow-up of 7.3 years, the rates of hematuria-related complications were 123.95 events per 1000 person-years among patients actively exposed to antithrombotic agents vs 80.17 events per 1000 person-years among patients not exposed to these drugs (difference, 43.8; 95% CI, 43.0-44.6; P < .001, and incidence rate ratio [IRR], 1.44; 95% CI, 1.42-1.46). The rates of complications among exposed vs unexposed patients (80.17 events/1000 person-years) were 105.78 for urologic procedures (difference, 33.5; 95% CI, 32.8-34.3; P < .001, and IRR, 1.37; 95% CI, 1.36-1.39), 11.12 for hospitalizations (difference, 5.7; 95% CI, 5.5-5.9; P < .001, and IRR, 2.03; 95% CI, 2.00-2.06), and 7.05 for emergency department visits (difference, 4.5; 95% CI, 4.3-4.7; P < .001, and IRR, 2.80; 95% CI, 2.74-2.86). Compared with patients who were unexposed to thrombotic agents, the rates of hematuria-related complications were 191.61 events per 1000 person-years (difference, 117.3; 95% CI, 112.8-121.8) for those exposed to both an anticoagulant and antiplatelet agent (IRR, 10.48; 95% CI, 8.16-13.45), 140.92 (difference, 57.7; 95% CI, 56.9-58.4) for those exposed to anticoagulants (IRR, 1.55; 95% CI, 1.52-1.59), and 110.72 (difference, 26.5; 95% CI, 25.9-27.0) for those exposed to antiplatelet agents (IRR, 1.31; 95% CI, 1.29-1.33). Patients exposed to antithrombotic agents, compared with patients not exposed to these drugs, were more likely to be diagnosed as having bladder cancer within 6 months (0.70% vs 0.38%; odds ratio, 1.85; 95% CI, 1.79-1.92).
Conclusions And Relevance:
Among older adults in Ontario, Canada, use of antithrombotic medications, compared with nonuse of these medications, was significantly associated with higher rates of hematuria-related complications (including emergency department visits, hospitalizations, and urologic procedures to manage gross hematuria).
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