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

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.