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Am Fam Physician. 2000;61(11):3443-3444

When patients on anticoagulant therapy present with gross hematuria, urologic evaluation is currently recommended. In past studies, significant pathologic findings were not found in 3 to 82 percent of such patients. Avidor and colleagues studied the feasibility of waiving certain urologic tests in patients on warfarin or aspirin therapy who present with gross hematuria. They also compared the underlying pathology in both groups of patients.

The authors performed a retrospective review of all patients on warfarin or aspirin therapy who were admitted to a medical center with gross hematuria. Patients underwent a history and physical examination, laboratory assessment, urine culture and testing for prostate-specific antigen level in men older than 50 years. The degree of anticoagulation for patients taking warfarin was also recorded. Cystoscopy and excretory urography or renal ultrasonography were used to evaluate almost all of the patients. Further studies were performed as indicated.

Patients taking warfarin had a normal evaluation more often than those taking aspirin (38 versus 22 percent, respectively). The leading pathologic findings in both groups were bleeding benign prostatic disease and urinary tract tumors. Overall, a urinary tract tumor was diagnosed in approximately 25 percent of patients, and other treatable pathologic findings were discovered in about 50 percent of the patients in the study group. A higher incidence of hemorrhagic cystitis occurred in the patients taking aspirin.

The authors conclude that when patients who are on warfarin or aspirin therapy present with gross hematuria, an evaluation of the urinary tract is warranted, even in the presence of excessive anticoagulation in patients taking warfarin.

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