Risk of incident genitourinary cancer following hematuria in patients with atrial fibrillation receiving oral anticoagulants

Ling Kuo; Yi-Hsin Chan; Jo-Nan Liao; Tzeng-Ji Chen; Gregory Y H Lip; Shih-Ann Chen; Tze-Fan Chao

doi:10.1016/j.hrthm.2024.11.043

Risk of incident genitourinary cancer following hematuria in patients with atrial fibrillation receiving oral anticoagulants

Heart Rhythm. 2024 Nov 28:S1547-5271(24)03627-0. doi: 10.1016/j.hrthm.2024.11.043. Online ahead of print.

Authors

Ling Kuo¹, Yi-Hsin Chan², Jo-Nan Liao¹, Tzeng-Ji Chen³, Gregory Y H Lip⁴, Shih-Ann Chen⁵, Tze-Fan Chao⁶

Affiliations

¹ Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
² The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Microscopy Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.
³ Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
⁴ Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK, Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg, University, Aalborg, Denmark.
⁵ Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan; Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.
⁶ Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan. Electronic address: eyckeyck@gmail.com.

PMID: 39613206
DOI: 10.1016/j.hrthm.2024.11.043

Abstract

Background: Hematuria is common in patients with atrial fibrillation (AF) on oral anticoagulants (OACs). However, risks of incident genitourinary (GU) malignancy and detailed etiologies of hematuria have not been well studied.

Objective: We aimed to investigate the risk of hematuria and underlying GU malignancy in patients with AF receiving OACs.

Methods: A total of 192,728 patients with AF receiving OACs were identified from Taiwan National Health Insurance Research Database. The risk of hematuria was compared between patients receiving warfarin (n = 75,541) and non-vitamin K antagonist OACs (NOACs) (n = 117,187). Among them, 18,509 patients experiencing hematuria without previous history of GU malignancy were defined as the study population. One-year risks of GU cancers were studied and compared between warfarin and NOAC users.

Results: Compared with warfarin, NOACs were associated with a higher risk of mild (2.29% per year vs 1.71% per year, adjusted hazard ratio [aHR] 1.107, P < .0001) or moderate hematuria (0.84% per year vs 0.62% per year, aHR 1.075, P = .0189), but a lower risk of severe hematuria (0.15% per year vs 0.17% per year, aHR 0.630, P < .0001). Within 1 year after hematuria, 738 (3.99%) patients were diagnosed with incident GU cancers, and the risk was higher among warfarin compared with NOAC users (4.10% vs 3.89%, odds ratio [OR] 1.1169, P = .041). Age ≥75 years (OR 1.486, P < .0001), male gender (OR 2.342, P < .0001) and abnormal renal function (OR 1.319, P = .0015) were important clinical factors associated with the diagnosis of GU cancer.

Conclusion: GU malignancy occurs in approximately 4% of anticoagulated patients with AF experiencing hematuria. Comprehensive evaluations of underlying etiologies of hematuria are necessary.

Keywords: Atrial fibrillation; Genitourinary malignancy; Hematuria; NOAC; Oral anticoagulants; Warfarin.