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No. 075. Oral anticoagulation does not affect the prevalence of asymptomatic microscopic haematuria: insights from a state-wide sample of patients undergoing elective non-urologic surgery.

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No. 075

Oral anticoagulation does not affect the prevalence of asymptomatic microscopic haematuria: insights from a state-wide sample of patients undergoing elective non-urologic surgery

PrassannahSATASIVAM, Daniel LENAGHAN, Gausihi SIVARAJAH, Benny ZHANG, Jo-Lyn MCKENZIE, Peter CHOONG, Jeremy GOAD, Janelle BRENNAN

St Vincent’s Hospital, Melbourne

Posters Proudly Supported by:

  • Introduction
  • Urologists are increasingly involved in the management of patients taking oral anticoagulation (OA).
  • In May 2012 the American Urological Association (AUA) released new guidelines for the evaluation and management of asymptomatic microscopic haematuria (AMH).
  • These guidelines recommend full urologic (and/or nephrologic) evaluation for AMH regardless of the type or level of anticoagulant therapy. The evidence for this recommendation, however, is limited.
  • Results
  • There were 239 male and 357 female patients.
  • The average age of patients was 68.4 years.
  • Patients with a history of current or prior smoking (n = 245) were no more likely to have AMH than those who had never smoked (16% vs. 18%, p = 0.5).
  • 36% of patients were taking OA (n = 216):
    • 174 were taking aspirin alone or in combination with other agents
    • 39 were taking warfarin
    • 13 were taking clopidogrel
    • 9 were on newer medications

Aims

1. To determine the prevalence of asymptomatic microscopic haematuria (AMH) by examining a cohort of patients undergoing elective non-urological surgery.

2. To determine whether patients taking oral anticoagulation (OA) were more likely to demonstrate AMH on routine urinalysis.

  • 17% of patients (n = 104) had AMH.
  • The prevalence of AMH was 15% (n = 59) among patients not taking oral anticoagulation and 21% (n = 45) among those who were.
  • Methods
  • 596 consecutive patients from Dec ‘11 to Nov ’12.
  • Elective hip and knee replacement surgery from ESAS program, chosen because:
    • Patients have no known active urological disease
    • Similar age group to patients with bladder cancer
    • All patients received preoperative MSU
    • State-wide coverage of ESAS program allows estimation of true population incidence
  • AMH defined as > 100,000 RBCs per litre.
  • Prospective data collection – age, sex, smoking status, type of oral anticoagulation if any.
  • Statistical significance ascribed to p < 0.05 on Pearson’s Chi-square and Student’s t-tests.

15%

  • On multivariate analysis, there was no significant association between the use of any single anticoagulant or combination of agents with the risk of detecting AMH (p = 0.21).

Conclusions

The prevalence of asymptomatic microscopic haematuria is 17% among patients referred for elective joint surgery in the State of Victoria.

The use of oral anticoagulation does NOT increase the risk of asymptomatic microscopic haematuria.

  • Discussion
  • The prevalence of AMH ranges from 2.4% to 31.1%, based on population studies of over 80,000 individuals.
  • Higher rates of AMH are seen in males > 60 years, and those who are current or past smokers.
  • Malignancy accounts for only 2.6% to 4% of causes. Other common urological causes include BPH, infection and urinary tract calculi.
  • 2012 AUA guidelines on AMH recommend full evaluation in patients on OA. Cuclasure et al (1994) showed no difference in the number of AMH episodes between OA patients (n = 69) and controls (n = 30).
  • Our data reinforce the AUA recommendations.
  • References
  • Davis et al, Diagnosis, Evaluation And Follow-up Of Asymptomatic Microhematuria (AMH) In Adults: AUA Guideline, May 2012
  • Rodgers et al, Diagnostic tests and algorithms used in the investigation of haematuria: systematic reviews and economic evaluation. Health Technology Assessment 2006; Vol. 10: No. 18.