Intravesical botulinum toxin-A injection for the treatment of overactive bladder in anticoagulated patients - Is it safe?

BAUS ePoster online library. Luton O. Jun 27, 2018; 211390
Mr. Oliver Luton
Mr. Oliver Luton
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Abstract
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Introduction: Intravesical Botulinum Toxin A (BoNT-A) injections are an effective treatment of overactive bladder refractory to medical therapies.
Currently there is a lack of evidence surrounding the risk of haemorrhage to anticoagulated patients receiving this treatment. This patient group was either excluded from clinical trials prior to publication of data or their anticoagulation was reversed prior to treatment.
The aim of this single centre study was to identify the rate of haematuria as significant adverse events (SAE) to this patient group.

Methods: Retrospective analysis of 353 procedures of intravesical BoNT-A using patient records over a 4 year period in a single centre.
SAE were defined as visible haematuria requiring admission.

Results: 353 procedures; Male (n = 75) Female (n = 278), mean age 60.7 years. 68 procedures recorded with patients receiving anticoagulant(AC)/Antiplatelets (AP) therapy (19.3%). Warfarin was the most commonly encountered anticoagulant (57.9%).
Of the patients taking AC/AP therapy SAE rate = 5.9% (n= 4) in comparison to 0% on those who were not on AC/AP. None of these patients required further surgical intervention. No mortalities associated with treatment.

Conclusions: Since licensing of intravesicle BoNT-A injection in 2012 the decision to discontinue antiplatelet / anticoagulant therapy has been subject to local guidance and risk/ benefit consideration for the individual patient with the aim of reducing the risk of bleeding.
This study shows that rates of haematuria are higher in patients taking antiplatelet/ anticoagulant therapy however the outcome of treatment is unaffected and there is no risk of serious morbidity or mortality.
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