Haematuria readmission rates in DOAC patients undergoing TURP/TURBTs and urinary tract biopsies – is there any need for a bridging plan?



How to Cite

Kanwar, T., & Li, A. (2021). Haematuria readmission rates in DOAC patients undergoing TURP/TURBTs and urinary tract biopsies – is there any need for a bridging plan?. The Physician, 7(2), 1-6. https://doi.org/10.38192/


Aim - The purpose of our quality improvement project was to reduce readmission rates for haematuria in patients on direct oral anticoagulants (DOACs) who had undergone a urinary tract biopsy or resection.

Methods - For each cycle we used operating lists, pre-assessment clerking and departmental inpatient lists to identify the proportion of patients on DOACs readmitted post-operatively within 1 month from date of surgery. Cycle 1 was completed over a six-month period. We then discussed these results with a Haematologist, who advised a bridging plan with low-molecular weight heparin to mitigate the risk. Following implementation of the bridging plan, we then completed the second cycle over a three-month period.

Results - The first cycle showed that 37.5% (n=16) of all patients on DOACs who had undergone one of these procedures were readmitted with significant haematuria. After implementation of the bridging plan with Low molecular weight heparin, the second cycle showed a reduced readmission rate of 33.3% (n=9), despite a higher percentage of patients on a DOAC in this cycle.

Discussion - There was no uniform practice or protocol for restarting DOACs in our hospital. After completion of this project, a uniform protocol has been established.

Recommendations included: (1) rediscuss with a Haematologist whether further measures were needed; present our data at a regional meeting to survey protocol and practices in neighbouring hospitals. Limitations included: a small sample size; non-uniform duration of data collection per cycle; reduction of elective operative lists due to COVID-19.



Heiman J, Large T, Krambeck A. Best practice in the management of benign prostatic hyperplasia in the patients requiring anticoagulation. Ther Adv Urol 2018;10:431–6. doi:10.1177/1756287218807591

Deitelzweig S, Baker CL, Dhamane AD, et al. Comparison of readmissions among hospitalized nonvalvular atrial fibrillation patients treated with oral anticoagulants in the United States. J Drug Assess;9:87–96. doi:10.1080/21556660.2020.1750418

Liang X, Wu W, Huang Y, et al. Safety of Surgery in benign Prostatic Hyperplasia Patients on Antiplatelet or Anticoagulant Therapy: A Systematic Review and Meta-Analysis. Urol J 2020;18:151–9. doi:10.22037/uj.v16i7.5974

Palmisano F, Boeri L, Fontana M, et al. Incidence and predictors of readmission within 30 days of transurethral resection of the prostate: a single center European experience. Sci Rep 2018;8:6575. doi:10.1038/s41598-018-25069-5

Unplanned urology readmissions in a district general hospital: are we meeting the standard? - M Raslan, Ms Floyd, S Itam, R Mukherjee, Pp Irwin, Sb Maddineni, 2013. https://journals.sagepub.com/doi/10.1177/2051415813487333 (accessed 14 Dec 2021).

Readmissions in the postoperative period following urinary diversion | SpringerLink. https://link.springer.com/article/10.1007%2Fs00345-010-0613-8 (accessed 14 Dec 2021).

Risk factors of hospital readmission after radical cystectomy and urinary diversion: analysis of a large contemporary series - Harraz - 2015 - BJU International - Wiley Online Library. https://bjui-journals.onlinelibrary.wiley.com/doi/10.1111/bju.12830 (accessed 14 Dec 2021).

Becker B, Netsch C, Hansen J, et al. Perioperative Safety in Patient Under Oral Anticoagulation During Holmium Laser Enucleation of the Prostate. J Endourol 2019;33:219–24. doi:10.1089/end.2018.0693

Beckmann A, Spalteholz J, Langer F, et al. Perioperative management of direct oral anticoagulants in patients undergoing radical prostatectomy: results of a prospective assessment. World J Urol 2019;37:2657–62. doi:10.1007/s00345-019-02668-z

Pose R, Langer F, Tennstedt P, et al. Management of Patients Receiving Direct Oral Anticoagulants Scheduled for Radical Prostatectomy: An Update of a Prospective Assessment. Eur Urol Focus 2021;:S2405-4569(21)00012-2. doi:10.1016/j.euf.2021.01.011

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