Impact of antiplatlet or anticoagulation therapy in patients newly diagnosed bladder cancer: Preliminary results of a independent analysis of the Identify Study Italian cohort

Aim of the study: The most common symptom of bladder cancer (BCa) is haematuria. Although macroscopic haematuria has long been assumed to be the earliest and most frequent symptom of BCa, its effect on current urologic practice deserves better investigation because of some novel epidemiologic and clinical findings. Antiplatelet and anticoagulant therapy (AAT) represents one of the most widely used treatments in medical practice. The aim of this study is to evaluate whether patients taking AAT might experience haematuria at an earlier stage or grade of BCa in the setting of IDENTIFY study: the largest ever prospective, international, multicentre study of patients referred to secondary care, with or without haematuria, for the investigation of suspected urinary tract cancer. Materials and methods: Data were collected prospectively from five Italian tertiary referral centers including 618 consecutive patients undergoing cystoscopy because of urothelial cancer suspicion and with no history of previous urological tumours, from December 2017 to May 2018. For the purpose of this sub-analysis patients with subsequent diagnosis of BCa were divided into two groups: patients receiving antiplatelet or anticoagulant therapy (AAT) and patients who are not receiving it at the moment of enrollment. Results: We included 109 patients with complete follow up and histopathology. 34 (31,2%) of patients took AAT at the time of enrollment. The mean age of the population was 72.3 years (±11.4, SD) and the majority of patients were males (88.9%). Distribution of data in BMI, smoke habits, family history of urological cancer, tumour focality, tumor size, tumour location, final pT stage, grading according to WHO and histologic variants of BCa was homogenous (all p > 0.05). Data regarding mean age at recruitment (p < 0.0001), gender (p = 0.02), type of haematuria (visible or not, p < 0.0001) were statistically significantly different between the two populations. A multivariable binomial logistic regression analysis adjusted for age, sex, tumour size, tumour focality, active smoke habit and AAT confirmed the absence of statistically significant differences in predict high grade or stage BCa at final pathology report (p = 0.43). Discussion: In this preliminary independent analysis of the Italian cohort of the IDENTIFY study, patients without history of urological malignacies undergoing cystoscopy because of suspicious urothelial cancer do not seem to experience haematuria significantly earlier (regarding pT stage and or grading) if using AAT. Whilst IDENTIFY definitive results are awaited to confirm our findings, investigation for suspect urothelial cancers should not differ from the standard in these patients.