Presentation Authors: Elsie Mensah, Bodgan Toia, Andrew Brown*, Linh Trang Nguyen, Rizwan Hamid, Mahreen Pakzad, Roger Walker, Jeremy Ockrim, Davendra Sharma, Tharani Nitkunan, Tamsin Greenwell, Jai Seth, London, United Kingdom
Introduction: Intravesical OnabotulinumToxin-A(Botox) injections are an established treatment for idiopathic and neurogenic detrusor overactivity(IDO and NDO). The patient population receiving this treatment is growing, in seniority and co-morbidity. There is little evidence regarding the safety of Botox injections in patients on anticoagulant/antiplatelet medication, the cessation of which may predispose to thromboembolic or ischaemic events. We have reviewed the number significant bleeding events after intravesical Botox injection in patients with concurrent anticoagulant/antiplatelet(AC/AP) use.
Methods: A retrospective review of all patients having Botox in 3 hospitals was conducted. Patients having Botox injections between January 2016 and July 2018, whilst on theraputic anticoagulant/antiplatelet medication were identified. Demographic data, indication for treatment, and bleeding requiring intervention were recorded.
Results: 532 patients had intravesical Botox injections during this time. 63 patients [mean age 69 years(range 19-89), had a total of 114 separate rounds of Botox injections whilst on AC/AP therapy. Of the 63, there were 33 males, with 46 having IDO and 17 with NDO. Each patient had between 1-7 repeat Botox injections during the studied period. AC/AP use across the 114 episodes included; aspirin 44, clopidogrel 37, warfarin 19, NOAC (novel/non-vitamin K oral anticoagulant) 14. Patients on warfarin who had point of care testing all had INR < 3. Botox dose varied from 100U to 300U â€“ modal dosage was 200U._x000D_
Table 1 shows the number of injection rounds received by the 63 patients. _x000D_
1/114(0.88%) injection episodes resulted in post-injection haematuria requiring overnight catheterisation with spontaneous resolution. This patient was on rivaroxiban and had 300U of Botox injected through 20 sites, on a background of previous prostate radiotherapy and self-catheterisation.
Conclusions: There was 1 significant bleeding event despite continuation of AC/AP therapy during intravesical Botox treatment. AC/AP therapy is traditionally a contraindication for Botox injection as per license and this study has demonstrated relative safety. Continuation of anticoagulation (AC/AP therapy and warfarin (INR < 3)) appears to be safe in patients having intravesical Botox injections.