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Antiplatelet, anticoagulant therapy may lead to earlier bladder cancer diagnosis
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Patients who receive antiplatelet or anticoagulant therapy appear to experience gross hematuria earlier than untreated patients, according to the results of a retrospective analysis.
Hematuria — a common presenting symptom of bladder cancer — when presented early may lead to a diagnosis of bladder cancer at a lower grade and stage, the researchers wrote.
Around 25% of patients diagnosed with bladder cancer presented with locally advanced or metastatic disease, Marco Moschini, MD, of the department of urology at Università Vita-Salute San Raffaele in Milan, and colleagues wrote.
Researchers sought to determine whether patients receiving antiplatelet and/or anticoagulant therapy (AAT) experienced hematuria at an earlier stage or grade of bladder cancer compared with untreated patients.
The analysis included data from 1,532 consecutive patients who presented at Università Vita-Salute San Raffaele’s ER between 2004 and 2012 with gross hematuria. Overall, 227 of these patients (median age, 68.7 years; 82.4% men) received a diagnosis of bladder cancer.
The researchers further divided patients into two groups: patients receiving AAT (group 1; n = 59) and patients not receiving AAT (group 2; n = 168) at the moment of a macroscopic hematuria episode.
Patients receiving AAT tended to be older (P = .01), have worse Charlson Comorbidity Index scores (P = .001) and have larger tumors (P = .01).
Results of a multivariate analysis showed patients in group 1 — or those receiving AAT — appeared less likely to have a high pathological stage (OR = 0.37; 95% CI, 0.12-0.66) and high tumor grade (OR = 0.56; 95% CI, 0.26-0.85) at the time of bladder cancer diagnosis.
The researchers acknowledged the potential for selection bias in retrospective studies and the lack of other defined causes of gross hematuria as limitations to these findings. Further, no blood tests occurred to ascertain AAT class group.
“Knowing a cheap and simple factor related to lower bladder cancer grade and stage could represent a useful and simple indicator at ER to define the risk and the priority to investigation in different patients at risk to have an undiagnosed bladder cancer,” Moschini and colleagues wrote. “Considering the absence of a real screening test for bladder cancer and the common characteristics between patients that underwent AAT and patients at risk to develop bladder cancer, this factor could be taken into account to develop it.” – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Marc C. Smaldone, MD, MSHP
This is a retrospective institutional cohort study in which the authors investigated bladder cancer outcomes in 1,532 patients presenting to their emergency department with gross hematuria. In patients diagnosed with bladder cancer (n=227), the authors evaluated grade and stage at presentation stratified by receipt of anti-platelet or anticoagulation therapy (AAT), reporting that patients receiving AAT presented with lower stage and grade tumors.
Acknowledging the methodologic limitations inherent to a retrospective study design, this study raises a number of important points. While a common malignancy, public awareness of bladder cancer has suffered due to lack of advocacy efforts and robust evidence to support screening programs. It is well accepted that patients on blood thinning medications are prone to episodes of gross hematuria, but it is unfortunately easy to overlook blood in the urine if easily attributable to prescribed medications. While it is difficult to assume a protective benefit to these medications, the most important teaching point from this study is that every episode of gross hematuria (history of blood thinners or not) should prompt an expeditious and thorough urologic evaluation.
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