Unusual Presentation of Bladder Tumour: Haematuria only after Administration of Anti-Platelet Drugs

Abstract

Anti-thrombotic agents are used for the treatment and prevention of cardiovascular diseases. Bleeding is the most important side-effect of these agents. The common causes of haematuria after anti-thrombotic administration are benign prostatic hyperplasia, haemorrhagic cystitis, renal calculi, renal infarction, infection, and adult polycystic kidney disease. Haematuria only after anti-thrombotic administration can be the presentation of a bladder tumour. Here, 71 years old male patient, with a bladder tumour was reported, who presented with haematuria only after he took dual anti-platelet drugs (tablet Ecosprin and tablet Clopidogrel). He took these drugs after he underwent the insertion of cardiac stents. He never had any previous history of haematuria. After the complaint, ultrasonography was performed and it reported a normal urinary system. So, the anti-platelet drugs were suspected to be the cause of haematuria. Tablet Clopidogrel was stopped and patient was sent home on Tablet Ecosprin. However, one month later, he again developed haematuria. Repeat imaging studies (ultrasonography and computed tomography) detected a urinary bladder mass. Transurethral resection of the mass was performed and a biopsy reported high-grade, muscle-invasive transitional cell carcinoma. This case highlights the fact that all cases of haematuria, irrespective of anti-thrombotic agents’ administration, should be suspected to be due to urological malignancy and the patients should undergo complete urological investigations, including cystoscopy.