From the Guidelines
Aspirin (ASA) should not be held in patients experiencing hematuria unless the bleeding is severe or directly attributed to the antiplatelet effect of aspirin. The decision to continue or hold aspirin requires careful consideration of the patient's underlying cardiovascular risk versus the severity and cause of the bleeding. According to a study published in The Journal of Urology 1, uninterrupted use of aspirin does not increase the risk of moderate/severe hematuria, hemospermia, or rectal bleeding after transrectal ultrasound-guided biopsy of the prostate (TRUSBx). This suggests that aspirin can be safely continued in patients with hematuria, unless there are other compelling reasons to discontinue it.
For patients on aspirin for secondary prevention (those with established cardiovascular disease, prior stroke, or myocardial infarction), the risks of discontinuation often outweigh the benefits, as stopping aspirin can increase the risk of thrombotic events 1. However, if the hematuria is significant (causing hemodynamic instability, requiring transfusions, or causing severe symptoms), aspirin should be temporarily discontinued until the bleeding is controlled and its cause is identified. Once the bleeding has resolved and the underlying cause has been addressed, aspirin therapy should be resumed as soon as safely possible, typically within 1-7 days depending on the severity of the bleeding and the patient's cardiovascular risk profile.
Key considerations in managing patients with hematuria on aspirin include:
- The severity and cause of the bleeding
- The patient's underlying cardiovascular risk
- The potential risks and benefits of discontinuing aspirin
- Consultation with both urology and cardiology specialists, particularly for patients with high cardiovascular risk
- Resuming aspirin therapy as soon as safely possible after the bleeding has resolved and the underlying cause has been addressed.
It is essential to weigh the risks and benefits of continuing or holding aspirin in patients with hematuria, considering the latest evidence and individualizing the decision based on the patient's specific clinical context 1.
From the FDA Drug Label
Stomach bleeding warning: This product contains an NSAID, which may cause severe stomach bleeding The FDA drug label does not answer the question.
From the Research
Aspirin (ASA) and Hematuria
- The decision to hold Aspirin (ASA) in patients experiencing hematuria should be based on the individual patient's risk-benefit analysis, considering the potential benefits of ASA in preventing cardiovascular disease and the potential risks of bleeding associated with hematuria 2, 3.
- A study published in the journal Urology in 2000 found that patients taking aspirin had a higher incidence of hemorrhagic cystitis compared to those taking warfarin, suggesting that aspirin may increase the risk of bleeding in the urinary tract 3.
- Another study published in Urology in 2018 found that antiplatelet agents, including aspirin, were 76 times less likely to cause hematuria compared to anticoagulants, but that the odds of hematuria with aspirin were 6.7 times the odds with clopidogrel and 3.5 times the odds with ticagrelor 4.
- The use of aspirin in patients with hematuria should be carefully considered, taking into account the potential benefits and risks, as well as the presence of any underlying urologic pathology 3, 4.
- There is no clear consensus on whether ASA should be held in patients experiencing hematuria, and the decision should be made on a case-by-case basis, considering the individual patient's clinical context and medical history 2, 3, 4.