Hematuria-related readmission after transurethral resection of bladder tumor in patients receiving antiplatelet therapy.

INTRODUCTION

Managing patients on antiplatelet (AP) therapy undergoing transurethral resection of bladder cancer (TURBT) is challenging due to bleeding and thromboembolic risks.

METHODS

We retrospectively analyzed patients who underwent TURBT between January 2020 and December 2024. Patients were divided into an AP group and a control group without AP therapy. Demographic, perioperative, and postoperative parameters, including low-molecular-weight heparin (LMWH) bridging, were evaluated. The primary endpoint was readmission due to hematuria within 30 days; secondary outcomes included rehospitalization, clot retention, and reoperation. Logistic regression analyses identified predictors of readmission.

RESULTS

A total of 103 patients were included, with 40 in the AP group and 63 in the control group. Readmission with hematuria occurred in 10% of AP patients versus 6.3% of controls (p = 0.707). All readmissions in the AP group involved clopidogrel users, alone or with acetylsalicylic acid (ASA), while none occurred in ASA-only users (p = 0.004). Rehospitalization was observed only in the AP group (7.5% vs 0%, p = 0.055). LMWH bridging (OR = 18.40, 95%CI = 2.93-115.40, p = 0.002) and clopidogrel use (OR = 10.88, 95% CI = 2.2851.94, p = 0.003) predicted readmission in univariable analysis but not multivariable models.

CONCLUSION

Perioperative ASA monotherapy appears safe, while clopidogrel use may increase the risk of hematuria-related readmission and warrants closer monitoring.