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Conference Proceeding

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Archives of Pathology & Laboratory Medicine


Context: Direct oral anticoagulants (DOACs) have gained wide use in prevention and treatment of thromboembolic diseases. Both major and nonmajor bleeding events have been reported. Hematuria is a common bleeding complication in patients receiving DOACs.

Design: This study retrospectively investigates the underlying urologic etiologies responsible for DOAC therapy–related macroscopic hematuria. During a 1-year period, hospitalized patients with prolonged PTT and DOAC therapy–related hemorrhage were identified. Medical chart review focused on urology consult and related laboratory and imaging findings.

Results: Among 93 patients with DOAC therapy–related hemorrhage, 15 had macroscopic hematuria (16%), including 11 men and 4 women with a median age of 75 years (range, 66–87 years). All patients received urology and/or nephrology specialist evaluation. Studies also included urine analysis and culture, computed tomography with urogram, and cystoscopy. The major pathologic findings were bladder diverticular and kidney cystic lesions in 6 patients, urolithiasis 4, cystitis 2, postsurgery catheter trauma 1, bladder cancer 1, and acute kidney injury 1. Fourteen patients presented with anemia and 1 patient died during hospitalization. DOAC therapy was held during the evaluation and 4 patients resumed DOAC therapy after the management of hematuria.

Conclusions: Macroscopic hematuria is a major bleeding complication associated with DOAC therapy. Anemia is common in these patients, but fatality is rare. Urology and/or nephrology evaluation and studies could identify the underlying cause in most patients. Bladder diverticular and kidney cystic lesions as well as urolithiasis were the most common urologic findings in this study. Some patients resumed DOAC therapy, but more patients had to switch to different antithrombotic agents.





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College of American Pathologists 2023 Annual Meeting CAP23, October 7-10, 2023, Chicago, IL

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