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Beitragstitel Impact of the type of anticoagulant therapy on hospitalization rate and length of hospital stay in patients with gross hematuria
Beitragscode P023
Autor:innen
  1. Piet Bosshard Inselspital, Universitätsspital Bern Präsentierende:r
  2. Martin Müller Inselspital, Universitätsspital Bern
  3. Aristomenis Exadaktylos Inselspital, Universitätsspital Bern
  4. Thomas Sauter Inselspital, Universitätsspital Bern
  5. Beat Roth Inselspital, Universitätsspital Bern
Präsentationsform moderierte Poster
Themengebiete
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Abstract-Text Background and Objective
Especially in anticoagulated patients, gross hematuria can be difficult to control, life-threatening and distressing. It may lead to poor compliance with the anticoagulant therapy and even an increased risk of death. Little is known about the influence of different types of anticoagulation - direct oral anticoagulants (DOAC: e.g. apixaban, dabigatran, edoxaban, rivaroxaban) vs. vitamin K antagonists (VKA) - on hospitalization rate and length of hospital stay (LOS) in patients with gross hematuria.

Material and Methods
This retrospective cohort study was conducted at the emergency department (ED) of a tertiary university hospital in Switzerland. All patients admitted with gross hematuria from January 2013 to December 2016 were included. We compared the primary clinical outcome parameters (hospitalization rate and LOS) as well as secondary outcomes (ICU admission, ED LOS, and in-hospital mortality) in patients with gross hematuria on either DOAC therapy, VKA therapy or no anticoagulants.

Results
811 patients presented with gross hematuria; 53 (6.5%) patients were on DOAC, 85 (10.5%) on VKA, and 673 (83.0%) patients had no anticoagulation therapy. In confounder-adjusted multivariable testing, there were fewer hospitalizations (odds ratio: 2.2, 95% CI: 1.1-4.9, p=0.028) and shorter LOS (geometric mean ratio: 2.2, 95% CI: 1.3-4.0, p=0.006) in patients on DOAC compared to patients on VKA. The secondary outcomes showed no significant difference between the three groups. No differences were found between the DOAC and no-anticoagulant group for any outcome.

Conclusions
Gross hematuria in patients on DOAC therapy is associated with fewer hospitalizations and shorter hospital stay compared to VKA. This finding that DOAC have some advantage over VKA medication may help urologists counsel the patient and his/her treating physician in the selection of anticoagulant therapy if there is a risk for gross hematuria/bleeding.