Avidor Y, Nadu A, Matzkin H
Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Israel.
Urology. 2000 Jan;55(1):22-4. doi: 10.1016/s0090-4295(99)00388-x.
To investigate the results of evaluations in patients presenting with gross hematuria while receiving anticoagulant or aspirin treatment and to compare the source of bleeding in these respective groups.
We retrospectively studied all patients admitted because of gross hematuria while receiving warfarin or aspirin treatment between 1990 and 1998. The degree of anticoagulation was evaluated in patients taking anticoagulation medication. Almost all patients were evaluated by cystoscopy and either excretory urography or ultrasound.
Patients taking warfarin had a normal evaluation almost twice as often as those taking aspirin: 38% versus 22%, respectively. The leading pathologic findings in both groups were a bleeding benign prostate and a tumor in the urinary tract, in similar proportions. Overall, a tumor was diagnosed in one quarter of patients, and other treatable pathologic findings were diagnosed about half the time. In the 11 patients receiving excessive anticoagulation medication, two tumors were found (18%). Hemorrhagic cystitis was diagnosed in 12 patients. All 12 were taking aspirin.
A normal evaluation was more prevalent in the warfarin group. A tumor was diagnosed in about one quarter of the patients. The prevalence of hemorrhagic cystitis in patients taking aspirin may point to a specific bleeding diathesis in the urothelium of these patients. In light of these findings, a full evaluation is warranted in patients receiving aspirin or warfarin therapy, and the presence of excessive anticoagulation should not impede a full evaluation.
研究接受抗凝剂或阿司匹林治疗的肉眼血尿患者的评估结果，并比较这些患者各自的出血来源。
我们回顾性研究了1990年至1998年间因肉眼血尿而接受华法林或阿司匹林治疗入院的所有患者。对服用抗凝药物的患者评估其抗凝程度。几乎所有患者均接受了膀胱镜检查以及排泄性尿路造影或超声检查。
服用华法林的患者评估结果正常的比例几乎是服用阿司匹林患者的两倍，分别为38%和22%。两组中主要的病理发现均为良性前列腺出血和尿路肿瘤，比例相似。总体而言，四分之一的患者被诊断为肿瘤，约一半的时间诊断出其他可治疗的病理发现。在11例接受过量抗凝药物治疗的患者中，发现了2例肿瘤（18%）。12例患者被诊断为出血性膀胱炎。所有12例均服用阿司匹林。
华法林组中评估结果正常更为普遍。约四分之一的患者被诊断为肿瘤。服用阿司匹林的患者中出血性膀胱炎的患病率可能表明这些患者的尿路上皮存在特定的出血素质。鉴于这些发现，接受阿司匹林或华法林治疗的患者有必要进行全面评估，抗凝过度的情况不应妨碍全面评估。
