Potential Effect of Antiplatelet and Anticoagulant Therapy on the Timing of the Diagnosis of Bladder Cancer

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Abstract

The most common presenting symptom of bladder cancer (BCa) is hematuria. However, the use of antiplatelet or anticoagulant therapy (AAT) is increasing. We report for the first time in published studies that patients diagnosed with BCa at an emergency room visit for an episode of macroscopic hematuria will have a lower tumor grade and stage if they were receiving AAT during the hematuria event.

Background:

The most common presenting symptom of bladder cancer (BCa) is hematuria. The present study was designed to define whether patients taking antiplatelet and/or anticoagulant drugs might experience hematuria at an earlier stage or grade of BCa.

Patients and Methods:

The data from 1532 consecutive patients who presented to the emergency unit of our institute from 2004 to 2012 because of gross hematuria as a single symptom were evaluated. Patients (n = 227) with a further diagnosis of BCa were included in our study. For the purpose of the present study, patients were divided into 2 groups: patients receiving antiplatelet or anticoagulant therapy (AAT) (group 1) and patients not receiving AAT (group 2) at the moment of the macroscopic hematuria episode. The effect of AAT on the pathologic stage and grade of BCa was statistically assessed using univariate and multivariate logistic regression analysis.

Results:

A total of 59 (26%) and 168 (74%) patients were included in groups 1 and 2, respectively. On multivariate logistic regression analysis, ATT conferred a protective effect against both pathologic stage ≥ T2 (odds ratio [OR], 0.37; 95% confidential interval [CI], 0.12–0.66; P = .01) and higher grade (OR, 0.56; 95% CI, 0.26–0.85; P = .02) at tumor presentation.

Conclusion:

According to the results of the present retrospective investigation, patients who received AAT seem to experience gross hematuria significantly earlier than do untreated patients, resulting in the chance of an earlier diagnosis and treatment of bladder cancer.

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