Risk of Hematuria-Related Complications Associated with Anticoagulant and Antiplatelet Medications: A Single-Institution Retrospective Cohort Study.

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY Urology Pub Date : 2024-11-13 DOI:10.1016/j.urology.2024.11.003

Joshua P Hayden, Jason Nelson, Edward Frankenberger, Alex J Vanni

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Abstract

Objective: To evaluate enteral and parenteral anticoagulant and antiplatelet medications and their associated risks of hematuria-related complications.

Materials and methods: This was a single-institution, retrospective cohort study. Primary outcomes were counts of ED visits, hospital admissions, and urologic procedures to manage gross hematuria that occurred while patients were exposed to anticoagulant/antiplatelet medications. Multivariable negative binomial regression was used to identify incidence density rates and rate ratios for hematuria-related complications associated with each anticoagulant/antiplatelet medication.

Results: Among 119,528 patients in the study cohort, 10,601 were exposed to rivaroxaban and 108,927 were not exposed to rivaroxaban. Patients who were prescribed rivaroxaban were more likely to be male (55.5% vs. 52.0%, p <.001), of white race (95.9% vs. 92.8%, p <.001), and have higher BMIs (median BMI, 29.3 vs. 28.3, p <.001). Those not exposed to rivaroxaban had lower incidence density rates than those exposed to rivaroxaban for any hematuria-related complication (29.4 vs. 39.3). Exposure to enoxaparin compared to rivaroxaban was associated with higher rates of any hematuria-related complication (adjusted risk ratio (aRR) 2.74, 95% CI 2.43-3.10), emergency department visits related to hematuria (aRR 3.34, 95% CI 2.73-4.11), and hematuria-related hospitalizations (aRR 4.58, 95% CI, 3.70-5.70). All other oral anticoagulant and antiplatelet medications studied were associated with lower risk than rivaroxaban for hematuria-related complications.

Conclusions: Among enteral and parenteral anticoagulant and antiplatelet medications studied, enoxaparin is associated with the highest rates of hematuria-related events. Further work is needed to elucidate the mechanisms by which distinct anticoagulant and antiplatelet medications contribute to hematuria.

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与抗凝剂和抗血小板药物相关的血尿并发症风险：单机构回顾性队列研究。

目的：评估肠内和肠外抗凝血和抗血小板药物及其相关的血尿并发症风险：评估肠内和肠外抗凝剂和抗血小板药物及其引起血尿相关并发症的相关风险：这是一项单一机构的回顾性队列研究。主要结果是患者在使用抗凝剂/抗血小板药物期间发生的急诊室就诊、入院和泌尿科手术治疗毛细血尿的次数。多变量负二项回归用于确定与每种抗凝剂/抗血小板药物相关的血尿相关并发症的发病密度率和比率比：在研究队列的 119,528 名患者中，10,601 人使用了利伐沙班，108,927 人未使用利伐沙班。获得利伐沙班处方的患者中男性比例更高（55.5% 对 52.0%，P 结论：男性患者更容易获得利伐沙班处方：在所研究的肠内和肠外抗凝药和抗血小板药物中，依诺肝素与血尿相关事件的发生率最高。需要进一步开展工作，阐明不同的抗凝药和抗血小板药物导致血尿的机制。

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来源期刊

Urology 医学-泌尿学与肾脏学

CiteScore

3.30

自引率

9.50%

发文量

716

审稿时长

59 days

期刊介绍： Urology is a monthly, peer–reviewed journal primarily for urologists, residents, interns, nephrologists, and other specialists interested in urology The mission of Urology®, the "Gold Journal," is to provide practical, timely, and relevant clinical and basic science information to physicians and researchers practicing the art of urology worldwide. Urology® publishes original articles relating to adult and pediatric clinical urology as well as to clinical and basic science research. Topics in Urology® include pediatrics, surgical oncology, radiology, pathology, erectile dysfunction, infertility, incontinence, transplantation, endourology, andrology, female urology, reconstructive surgery, and medical oncology, as well as relevant basic science issues. Special features include rapid communication of important timely issues, surgeon''s workshops, interesting case reports, surgical techniques, clinical and basic science review articles, guest editorials, letters to the editor, book reviews, and historical articles in urology.