Can blood in urine be caused by too much alcohol if on Apixaban?

[Eddie49]

I have been on Apixaban for about eighteen months with no issues whatsoever. Over the last week or so my urine has been intermittently very dark and yesterday it was definitely blood, and again this morning. I have light stabbing pains in my groin. I saw the G.P. yesterday who said I haven't got an infection. He checked my prostate which is ok and I am to have blood tests next Tuesday and I have been referred to the hospital. I had a thought this morning - I do drink too much alcohol, cans of beer in the evening. Doesn't affect my AF but can this be a cause of the bleeding do you think?

[Sfhmgusa]

I’m not a doctor so this is a very lay persons view, but I think it unlikely that beer in quantity would get blood in the urine.

I think you are doing the very right thing having all the tests done. One “ good” thing about anticoagulants is that they show some things up early by bleeding more than an uncoagulated person.

Usually there are many more harmless explanations for these things than bad ones, keep pestering the medics until you know what is behind it

Steve

[Eddie49 in reply to Sfhmgusa]

Thanks Steve. Mike

[Hidden in reply to Eddie49]

Agree with Steve, there are loads of minute blood vessels and it’s easy for one or more to rupture for a variety of different reasons and of course, any anticoagulant is likely to make the situation look worse than it probably is.

To be on the safe side, it needs to be thoroughly checked out so I expect your urine will be checked several times to see if the situation resolves itself......

[Eddie49 in reply to Hidden]

Thank you, I'm grateful.

[BobD Volunteer]

Excess alcohol can exacerbate the effect of anticoagulants. Does your doctor know how much you drink each evening? Might be an idea to avoid it for a few days.

[Eddie49 in reply to BobD]

I did tell him about my cans of beer every evening. I will take your advice about abstaining. Thank you Bob.

[Hidden]

Eddie, in addition to BobD’s comments, there may be something else worth considering. I am not medically trained but it is commonly known that DOAC’s are dependent on the kidneys for allowing excess chemicals to naturally leave the body. As far as I know, DOAC’s have no detrimental effect on the kidneys but it is essential that the kidney function is checked regularly with blood tests. Depending on the patients personal circumstances, this is should be done every 3 or 6 months, certainly once a year. Unfortunately, from what we hear, not all GP’s are aware but the requirement is clearly defined in the NICE guidelines for anticoagulation. Click on the link below is to reach their webpage then click on “scenario Apixaban” and scroll down to “How should I monitor someone taking Apixaban”.

cks.nice.org.uk/anticoagula...

In the meantime, it would be better to ease off all alcohol until you are confident that your kidneys are functioning OK. It’s highly likely not to be anything serious but this possibility needs to be checked out as soon as possible.

If you have online access to your blood test results, the one to look out for is Creatinine clearance. Hope this helps.......

[Eddie49 in reply to Hidden]

Thank you for that. I have had kidney stones in the past and also had my gall bladder removed about three years ago.

[Hidden]

Kidney stones can cause pain, and/or blood in the urine. Anticoagulants can make the bleeding worse.

[Eddie49 in reply to Hidden]

Thank you Badger. I had an op. for removal of kidney stones about twelve years ago. Possibly I have a stone in the bladder this time given where the pain is. The blood in the urine is a bit concerning but hopefully nothing sinister. Unfortunately I have to go into hospital for tests which really I don't want to do given the present climate.

[Gmc54]

Please go and tell your GP. He will need a blood sample. It's important you go sooner rather than later.

[Eddie49 in reply to Gmc54]

Will do. Thanks.

[opal11uk]

Blood in urine gives advance warning of possible problems both along the urinary tract and the kidneys, you have done the right thing by alerting your doctor urgently. Excess of any kind is bad for the body so it is advisable to cut down on your alcohol consumption, difficult at the moment I know. Good luck

[Eddie49 in reply to opal11uk]

I know. It is difficult. I either want a couple of pints to take my mind off problems or have a couple to celebrate when everything is going ok. 😀 Thanks.

[UnsteadyArcher in reply to Eddie49]

I used to drink too much, it was wine or beer every night. For me, the thought of giving up alcohol was worrying, but when I did it, it was much easier than I thought it would be. It helped that my AF stopped straight away, despite 3 cardioversions failing, and it hasn't been back ( nearly 18 months since I stopped drinking ). I feel great, especially in the mornings, I no longer get hot sweats at night, have lost weight and feel more agile than I have for years. After a couple of months the desire for a beer or glass of wine disappeared completely and I have no problem pouring my wife a glass or two of wine and a ginger beer for myself. Looking back, I can't believe I poisoned myself for so many years when I could have felt so much better.

[Eddie49 in reply to UnsteadyArcher]

Thanks for your reply. To my knowledge I have only had two episodes of AF, both after swimming in the sea and swimming baths. I am a good weight, fit, seem to be able to eat and drink what I like. I have always said (to myself that is) that I would give up anything that I felt was affecting my quality of life. I have not, so far, had to put my resolve to the test so do not know how difficult I would find this if needed.

[UnsteadyArcher in reply to Eddie49]

My AF was constant, and it affected my quality of life. The specialist offered me ablation, but I decided to make changes myself to see if it could be stopped another way. I tried excluding many "triggers", from cheese to peanut butter, it appears the culprit was red wine, but I just gave up drinking any alcohol and I'm glad I did. I genuinely feel years younger through not drinking.

[Karendeena in reply to UnsteadyArcher]

I did the same, used to love my wine and drink every night. Gave up last July when diagnosed with afib. Although I still get episodes I don't miss the wine now at all!

[Singwell]

Everything as above. I'd have said kidney issues till you explained about the stones. Hope you'll get it sorted soon. Being on anticoagulants you will bleed more so it's important. Do go get checked out.

[Eddie49 in reply to Singwell]

Thanks, I'm grateful. 👍

[Simonclermont]

Eddie, I found your post on recent episodes of blood in your urine very interesting.I'm 62 and have been on Apixaban for over 20 years now.

Like you, I also arguably drink a bit too much ( 2 decent scotches in the evening but never more )

4 years ago I had two episodes close together of noticing that my urine was a bit pink ( not just dark urine ) which had to be blood I felt.

Had the usual blood & urine tests and also had it checked out at the Norfolk & Norwich Hospital with a flexible tube down the penis.

They could find nothing of interest at all and suggested I monitor the situation.

They said sometimes they never find what the cause is !?

A couple of months ago ( 4 YEARS LATER ) I had another couple of episodes close together which rather startled me. Small but definitely there.

Explained the history to the GP and he organised blood and urine tests which again both came back clear of infection, prostate problem or anything else of interest.

He has booked me into the local urology department beginning of March so that all bases can be covered.

Due diligence he calls it.

No further episodes at all since then ( and let me tell you I inspect each trip to the loo in detail ! ).

It may be a red herring but when I try and think back to each of the 2 periods in the past the only common denominator I can see is that each episode happened following a hot shower !?

They were both in the morning as well.

Think you're doing exactly the right thing to have it checked out .

It will give you peace of mind I'm quite sure.

[Eddie49 in reply to Simonclermont]

Your experience is very similar to mine. I have had urology tests three times. I don't like it when they put that flexi snake down there where I don't want it to go! I have had kidney stones and gall bladder removal which I think were possibly linked to the previous blood shows I had. This happened before I was put on Apixaban about eighteen months ago. The blood stopped as quickly as it started and the same seems, hopefully, to be happening now. I am awaiting results of the urine test that was sent to the lab by the G.P., though he could see no infection. Blood test next week and await the call from Urology in hospital. That's something to look forward to. Mike

[Karendeena]

Hi Eddie, it's difficult to say what's the cause, but this happened to my mum many years ago and she had a form of bladder cancer that was successfully treated She was 62 at the time and she's now approaching 93! I am not saying it's this but hood you're getting tested. Good luck 👍

[Eddie49 in reply to Karendeena]

Thanks.

[john-boy-92]

Anticoagulants may cause occasional light bleeding. I take Pradaxa anticoagulant and Finasteride for an enlarged prostate; both can cause occasional brief bleeding. I'm a bit wary of reporting it, as invariably clinicians want to do a cystoscopy: I've had loads that have all been clear. Back in the day I had occasional bleeds when running 30 to 50 miles / week. Since I've been on Pradaxa, I have a kidney function test every six months. I've had ultrasound and CT contrast dye scans of my kidneys, and those have always been clear. I should add that males of fifty and over should have their prostate checked - that's for another discussion - but be aware that an enlarged prostate can cause occasional bleeding, as can an enlarged testicle.

A urinary tract infection (UTI) can cause a small amount (sometimes invisible) of blood.

[Eddie49 in reply to john-boy-92]

Thank you for that. I have had three cystoscopy's over the past ten years or so. The last one was just over three years ago with everything being clear. I saw my G.P. last week who has referred me again to Haematuria Clinic so I suspect another cystoscopy is coming my way. The last report says I should have been referred for a Contrast CT Urogram but I never was so perhaps I will have that as well this time.

[john-boy-92 in reply to Eddie49]

The contrast urogram, is like a standard CT, but it will automatically inject a small amount of contrast agent into your arm; you might get a warm sensation in your throat, like drinking a cheaper blended whisky! I only had one issue when the injection pressure was too high and caused phlebitis. Since then, I ask the radiographer to do a test run with saline.

[pascaltaskin]

Perhaps another red herring, but I've noticed blood in urine after medium-long walks recently. That seems to be about the only thing in common with occasional mild bleeds. I've been on Apixaban for about a year, having transferred from Rivaroxaban which I just about tolerated for a couple of months despite quite a lot of bleeding while I was on it. Not good. I also had a TURP procedure (Trans-Urethral Resection of the Prostate - basically a re-bore) last August, having been catheterised for the previous 3-4 months - and what a relief to get rid of the catheter tube!! GP initially said it was not unusual still to have some bleeding 3-4 months after a TURP, which surprised me, but now, after 6 months he's agreed to look into it further. I'm due to have a telephone follow-up with the urology surgeon next week, who was brilliant, so I'm hoping he may be able to shed some light on things. It has also been suggested that coffee can be a bladder irritant and lead to bleeding; but I drink very little coffee nowadays, and alcohol is limited to usually one glass with supper, often none, with the occasional gin to liven things up a little, so I don't think that's responsible for the problem.

[Eddie49 in reply to pascaltaskin]

Thanks. I will be glad to get the tests done. I am terrible for dwelling on the worse outcomes and getting myself in a bit of a state.