September 2, 2021
Hematuria with heparin in a cancer patient
This situation demonstrates the drawbacks of using LMWH in patients with renal failure. It also emphasizes the need to calculate creatinine clearance (CrCl), rather than just serum creatinine in elderly and frail patients. The calculated creatinine clearance in this case is 21 ml/min. At such low ranges of creatinine clearance, LMWH can cause hemorrhaging and should not be used.It is recommended that UFH be used to provide full anticoagulation therapy in patients with severe renal insufficiency. If LMWH is chosen, monitoring should be performed with therapeutic anti-factor Xa activity. The lowest ratio of CrCl levels for patients in this indication category probably varies for different LMWHs, but a safe threshold is likely to be 30 mL/min.
Significant pathological findings consisting of carcinoma, calculi, renal infarction, infection, benign prostatic hyperplasia and/or adult polycystic renal disease. A thorough and appropriate evaluation of the urinary tract should be conducted in patients on anticoagulant therapy who have gross or microscopic hematuria, since a pathological lesion of variable clinical significance often is discovered. [Source]
Clinical Bottom Line: Adult patients on anticoagulant therapy presenting to the Emergency Department with haematuria require complete genitourinary system investigation. [Source]