Transurethral resection of bladder tumour (TURBT) is a common urological procedure, primarily for urothelial carcinoma, with smoking being the leading risk factor. Many patients are on antithrombotic agents (ATAs – antiplatelets or anticoagulants), which increase bleeding risks. Despite guidelines on preoperative ATA cessation, postoperative restart protocols remain unclear. This study evaluated factors linked to emergency readmission for haematuria after TURBT. A retrospective analysis of 443 TURBT patients (79.5% male, median age 75) across 12 UK hospitals found that 33.2% were on ATAs preoperatively. The 30-day emergency readmission rate for haematuria was 3.4%, with ATA users at higher risk (6.1% vs. 2.0% non-users). Notably, non-aspirin ATAs (e.g., DOACs, clopidogrel) increased readmission risk to 10.5% (p=0.0015). Only one thrombotic event (PE) occurred, despite 54.7% of non-aspirin ATAs being resumed within 48 hours, 22.1% lacked restart documentation. Key predictors of readmission included male sex, ATA use, multifocal/large tumours (>3cm), monopolar diathermy, and detrusor muscle presence in specimens. However, no patients required surgical intervention for bleeding, and morbidity was low. Compared to historical data, this cohort had fewer reoperations, though haematuria rates aligned with prior studies where ATAs were withheld preoperatively. The findings highlight clinical dilemmas: balancing bleeding risks against thrombotic events, particularly with newer ATAs (e.g., DOACs) that lack monitoring/reversal options. While haematuria is more common than thrombosis post-TURBT, its management is typically less severe. The study underscores variability in postoperative ATA management and calls for standardised guidelines. Non-aspirin ATAs significantly increase haematuria-related readmissions after TURBT. Prospective studies are needed to refine perioperative ATA protocols, ensuring optimal thromboprophylaxis without excessive bleeding risk.
Haematuria after transurethral resection of bladder tumour
Reviewed by Asif H Ansari
HaEmaturia After Transurethral resection of bladder Tumour (HEATT): A multicentre, regional collaborative analysis of factors associated with emergency re-admission with haematuria following TURBT.
