Management of Hematuria in Patients on Antiplatelet Therapy

Assessment and Management Recommendations

In patients with hematuria who are on antiplatelet therapy, aspirin should be continued while clopidogrel (Plavix) should be temporarily discontinued for 5 days, especially if the bleeding is moderate to severe 1, 2
For patients with coronary stents on DAPT, never withhold both antiplatelet agents due to high risk of stent thrombosis 1
For patients on DAPT with aspirin and clopidogrel, continue aspirin and temporarily withhold clopidogrel 1
In patients with drug-eluting coronary stents, early resumption of P2Y12 receptor inhibitor (clopidogrel) is recommended, preferably within 5 days after bleeding is controlled 1
Aspirin can generally be continued during episodes of mild hematuria 2
Patients with recent coronary stent placement (especially drug-eluting stents within 6-12 months) have high thrombotic risk if antiplatelet therapy is discontinued 3, 4
For moderate to severe hematuria, resume antiplatelet therapy as soon as adequate hemostasis is achieved 1
In patients with drug-eluting coronary stents, P2Y12 inhibitors should be resumed within 5 days 1
Consider consulting a cardiologist before stopping antiplatelet therapy in patients with recent coronary stent placement (within 12 months) 3, 5
Antiplatelet therapy discontinuation is associated with high risk of stent thrombosis (HR of 161 for death and MI) 4
Consider switching to a different antiplatelet agent if hematuria recurs (e.g., from aspirin to clopidogrel or vice versa) 4, 6