Macrohematuria in the Course of Rivaroxaban Therapy: A Case of Bladder Tumor

Background: Rivaroxaban is a directly acting, oral anti-coagulant (factor Xa inhibitor) which is used to treat and prevent the formation of blood clots. A common side effect of this drug is an increase in bleeding tendencies, which can potentially lead to macroscopic hematuria. However, it is important to note that macroscopic hematuria can appear in several other conditions including urological malignancies. The Case: We report a case of a 69-year-old male patient with a history of myocardial infarction undergoing long term Rivaroxaban therapy, presenting with macroscopic hematuria and frequent urination. The clinical history and presenting symptoms were consistent with the side effects of prolonged use of Rivaroxaban, but further investigations revealed the presence of a tumor in the bladder which was instead found to be the cause of macroscopic hematuria. The conclusion: Although macroscopic hematuria is a very common side effect of Rivaroxaban therapy, it is important to consider other conditions which can present with the same symptoms.