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

Abstract

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.