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      Haematuria readmission rates in DOAC patients undergoing TURP/TURBTs and urinary tract biopsies – is there any need for a bridging plan?

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      The Physician
      British Association of Physicians of Indian Origin

            Abstract

            Aim - The purpose of our quality improvement project was to reduce readmission rates for haematuria in patients on direct oral anticoagulants (DOACs) who had undergone a urinary tract biopsy or resection. Methods - For each cycle we used operating lists, pre-assessment clerking and departmental inpatient lists to identify the proportion of patients on DOACs readmitted post-operatively within 1 month from date of surgery. Cycle 1 was completed over a six-month period. We then discussed these results with a Haematologist, who advised a bridging plan with low-molecular weight heparin to mitigate the risk. Following implementation of the bridging plan, we then completed the second cycle over a three-month period. Results - The first cycle showed that 37.5% (n=16) of all patients on DOACs who had undergone one of these procedures were readmitted with significant haematuria. After implementation of the bridging plan with Low molecular weight heparin, the second cycle showed a reduced readmission rate of 33.3% (n=9), despite a higher percentage of patients on a DOAC in this cycle. Discussion - There was no uniform practice or protocol for restarting DOACs in our hospital. After completion of this project, a uniform protocol has been established. Recommendations included: (1) rediscuss with a Haematologist whether further measures were needed; present our data at a regional meeting to survey protocol and practices in neighbouring hospitals. Limitations included: a small sample size; non-uniform duration of data collection per cycle; reduction of elective operative lists due to COVID-19.

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            Journal
            The Physician
            phy
            British Association of Physicians of Indian Origin
            2732-5148
            2732-513X
            October 11 2021
            December 14 2021
            : 7
            : 2
            : 1-6
            Article
            10.38192/1.7.2.3
            1183f392-2cea-4bad-919f-ae140da3f03e
            © 2021

            https://creativecommons.org/licenses/by-nc-nd/4.0

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