Does antithrombotic use enable earlier diagnosis of bladder cancer? A brief institutional assessment

• Published in: Canadian journal of urology Vol. 29; no. 6; p. 11391
• Main Authors: Shah, Yash B, Clark, Cassra B, Shumaker, Andrew, Denisenko, Andrew A, Alfonsi, Samuel, Prebay, Zachary, Schultz, Joseph, Mico, Vasil, Swaminathan, Vishal, Wang, Roy, Mark, James R, Trabulsi, Edouard J, Lallas, Costas D, Mann, Mark J, Goldberg, Hanan, Chandrasekar, Thenappan
• Format: Journal Article
• Language: English
• Published: Canada 01-12-2022
• Subjects: Anticoagulants - therapeutic use; Hematuria - etiology; Humans; Neoplasm Invasiveness; Retrospective Studies; Urinary Bladder Neoplasms - pathology; hematuria; anti-coagulation; antithrombotic medications; cancer staging; bladder cancer
• ISSN: 1195-9479

Wallis et al (JAMA 2017) demonstrated use of antithrombotic medications (ATMs) is associated with increased prevalence of hematuria-related complications and subsequent bladder cancer diagnosis within 6 months. Stage of diagnosis was lacking in this highly publicized study. This study examined the association of ATM use on bladder cancer stage at the time of diagnosis.
We completed a retrospective chart review of patients with a bladder cancer diagnosis at our institution. Patient demographics and bladder cancer work up information were assessed. Patients were stratified based on use of ATMs at time diagnosis. Descriptive statistics were completed to identify association between ATM use and stage of bladder cancer diagnosis, as stratified by non-muscle invasive bladder cancer (NMIBC) versus muscle invasive bladder cancer (MIBC).
A total of 1052 patient charts were reviewed. Eight hundred and forty-four were included and 208 excluded due to unavailability of diagnosis history. At diagnosis, 357 (42.3%) patients were taking ATMs. Patients on ATMs presented with NMIBC at similar rates as patients not taking ATMs (81.2% vs. 77.8%, p = 0.23). Subgroup analysis by ATM class similarly demonstrated no statistically significant differences in staging.
While Wallis et al established that patients on blood thinners who present with hematuria are more likely to be diagnosed with genitourinary pathology, this factor does not appear to enable an earlier diagnosis of bladder cancer. Future study may assess hematuria at presentation (gross, microscopic), type of blood thinners, and low versus high risk NMIBC presentation.