{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T08:39:18Z","timestamp":1774946358997,"version":"3.50.1"},"reference-count":93,"publisher":"IMR Press","issue":"3","license":[{"start":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T00:00:00Z","timestamp":1772755200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Cardiovasc. Med."],"abstract":"<jats:p>Hematuria is a frequent urological presentation, particularly in patients with significant cardiovascular comorbidities who receive dual antiplatelet therapy (DAPT) after acute coronary syndrome (ACS). Managing hematuria in this high-risk population poses a unique clinical challenge, requiring a careful balance between thrombotic and bleeding risks. This review summarizes current evidence and provides practical recommendations for the multidisciplinary management of hematuria in patients on antiplatelet medications following ACS. Relevant literature and international guideline recommendations from urology, cardiology, and emergency medicine were reviewed, focusing on diagnostic evaluation, hemodynamic assessment, modification of antiplatelet therapy, surgical considerations, and reversal strategies. The management pathway begins with a prompt assessment of hemodynamic stability, hematuria severity, and underlying cause. Conservative measures include catheterization, bladder irrigation, and correction of coagulation disorders. The diagnostic evaluation should not be delayed, as up to 24% of cases of visible hematuria in this population are due to malignancy. Antiplatelet management depends on bleeding severity and thrombotic risk: mild bleeding generally allows continuation of DAPT; moderate bleeding may warrant temporary cessation of aspirin; severe bleeding often requires de-escalation to monotherapy; life-threatening bleeding necessitates immediate discontinuation of all antiplatelets. Interventional options\u2014ranging from endoscopic clot evacuation to selective arterial embolisation\u2014should be tailored to the stability and cardiovascular risk of the patient. Resumption of antiplatelet therapy should occur as early as clinically feasible, ideally within 48 hours, with de-escalated regimens considered for patients with a high bleeding risk. Hematuria in post-ACS patients on antiplatelets requires an individualized, multidisciplinary approach to optimize hemostasis without compromising cardiovascular protection. Early diagnosis of underlying urological pathology is essential, and both bleeding severity and ischemic risk should guide antiplatelet modification therapy. Evidence supports early specialist involvement, adherence to structured risk-adapted protocols, and judicious use of conservative or interventional measures to improve outcomes.<\/jats:p>","DOI":"10.31083\/rcm46334","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T07:28:46Z","timestamp":1774942126000},"source":"Crossref","is-referenced-by-count":0,"title":["Hematuria Management in Patients on Antiplatelet Medications After Acute Coronary Syndrome: A Review of the Current Evidence and Recommendations"],"prefix":"10.31083","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-8118-1493","authenticated-orcid":true,"given":"Ioannis","family":"Loufopoulos","sequence":"first","affiliation":[{"name":"Urology Department, Ipswich Hospital, IP4 5PD Ipswich, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Konstantinos","family":"Kapriniotis","sequence":"additional","affiliation":[{"name":"Department of Urology, Whipps Cross Hospital, Barts Health NHS, E11 1NR London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0019-0134","authenticated-orcid":true,"given":"Barbara","family":"Fyntanidou","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Aristotle University of Thessaloniki, AHEPA General University Hospital of Thessaloniki, 54636 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6391-3478","authenticated-orcid":true,"given":"Aikaterini","family":"Apostolopoulou","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Aristotle University of Thessaloniki, AHEPA General University Hospital of Thessaloniki, 54636 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3057-5297","authenticated-orcid":true,"given":"Athina","family":"Nasoufidou","sequence":"additional","affiliation":[{"name":"2nd Cardiology Department, Ippokrateio General Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1657-4696","authenticated-orcid":true,"given":"Panagiotis","family":"Stachteas","sequence":"additional","affiliation":[{"name":"2nd Cardiology Department, Ippokrateio General Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8328-5942","authenticated-orcid":true,"given":"Efstratios","family":"Karagiannidis","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Aristotle University of Thessaloniki, AHEPA General University Hospital of Thessaloniki, 54636 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3069-3066","authenticated-orcid":true,"given":"Efstathios","family":"Papaefstathiou","sequence":"additional","affiliation":[{"name":"Urology Department, Russell's Hall Hospital DGFT, DY1 2HQ Dudley, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"16242","published-online":{"date-parts":[[2026,3,6]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Bhatt NR, Davis NF, Nolan WJ, Flynn RJ, McDermott T, Thomas AZ, et al. Incidence of Visible Hematuria Among Antithrombotic Agents: A Systematic Review of Over 175,000 Patients. Urology. 2018; 114: 27\u201332.","DOI":"10.1016\/j.urology.2017.11.023"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Eberli D, Chassot PG, Sulser T, Samama CM, Mantz J, Delabays A, et al. Urological surgery and antiplatelet drugs after cardiac and cerebrovascular accidents. The Journal of Urology. 2010; 183: 2128\u20132136.","DOI":"10.1016\/j.juro.2010.02.2391"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Culkin DJ, Exaire EJ, Green D, Soloway MS, Gross AJ, Desai MR, et al. Anticoagulation and antiplatelet therapy in urological practice: ICUD\/AUA review paper. The Journal of Urology. 2014; 192: 1026\u20131034.","DOI":"10.1016\/j.juro.2014.04.103"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. 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Renal diseases associated with hematuria in children and adolescents: a brief tutorial. Ultrastructural Pathology. 2012; 36: 1\u201318.","DOI":"10.3109\/01913123.2011.620731"},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"Bolenz C, Schr\u00f6ppel B, Eisenhardt A, Schmitz-Dr\u00e4ger BJ, Grimm MO. The Investigation of Hematuria. Deutsches Arzteblatt International. 2018; 115: 801\u2013807.","DOI":"10.3238\/arztebl.2018.0801"},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"Schulman S, Anger\u00e5s U, Bergqvist D, Eriksson B, Lassen MR, Fisher W, et al. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in surgical patients. Journal of Thrombosis and Haemostasis: JTH. 2010; 8: 202\u2013204.","DOI":"10.1111\/j.1538-7836.2009.03678.x"},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"Tomaselli GF, Mahaffey KW, Cuker A, Dobesh PP, Doherty JU, Eikelboom JW, et al. 2020 ACC Expert Consensus Decision Pathway on Management of Bleeding in Patients on Oral Anticoagulants: A Report of the American College of Cardiology Solution Set Oversight Committee. Journal of the American College of Cardiology. 2020; 76: 594\u2013622.","DOI":"10.1016\/j.jacc.2020.04.053"},{"key":"ref20","unstructured":"Haute Autorit\u00e9 de Sant\u00e9. Les anticoagulants oraux. Saint-Denis La Plaine: HAS. 2018. Available at: https:\/\/www.has-sante.fr\/jcms\/c_2851086\/fr\/les-anticoagulants-oraux (Accessed: 19 September 2025). (In French)"},{"key":"ref21","doi-asserted-by":"publisher","unstructured":"Pernod G, Godi\u00e9r A, Gozalo C, Tremey B, Si\u00e9 P, French National Authority for Health. French clinical practice guidelines on the management of patients on vitamin K antagonists in at-risk situations (overdose, risk of bleeding, and active bleeding). Thrombosis Research. 2010; 126: e167\u2013e174.","DOI":"10.1016\/j.thromres.2010.06.017"},{"key":"ref22","doi-asserted-by":"publisher","unstructured":"Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet (London, England). 2000; 356: 1318\u20131321.","DOI":"10.1016\/S0140-6736(00)02816-6"},{"key":"ref23","doi-asserted-by":"publisher","unstructured":"Berger PB, Bhatt DL, Fuster V, Steg PG, Fox KAA, Shao M, et al. Bleeding Complications With Dual Antiplatelet Therapy Among Patients With Stable Vascular Disease or Risk Factors for Vascular Disease. Circulation. 2010; 121: 2575\u20132583.","DOI":"10.1161\/CIRCULATIONAHA.109.895342"},{"key":"ref24","doi-asserted-by":"publisher","unstructured":"Valgimigli M, Bueno H, Byrne RA, Collet JP, Costa F, Jeppsson A, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal. 2018; 39: 213\u2013260.","DOI":"10.1093\/eurheartj\/ehx419"},{"key":"ref25","doi-asserted-by":"publisher","unstructured":"Carson JL, Brooks MM, H\u00e9bert PC, Goodman SG, Bertolet M, Glynn SA, et al. Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia. The New England Journal of Medicine. 2023; 389: 2446\u20132456.","DOI":"10.1056\/NEJMoa2307983"},{"key":"ref26","unstructured":"NHS Blood and Transplant. Blood Components: Terms. 2025. Available at: https:\/\/www.bloodcomponents.org.uk\/ (Accessed: 19 September 2025)."},{"key":"ref27","unstructured":"UK Clinical Pharmacy Association. Dual Antiplatelet Therapy \u2013 UKCPA Handbook of Perioperative Medicines. 2019. Available at: https:\/\/periop-handbook.ukclinicalpharmacy.org\/drug\/dual-antiplatelet-therapy\/ (Accessed: 19 September 2025)."},{"key":"ref28","doi-asserted-by":"publisher","unstructured":"Valle JA, Shetterly S, Maddox TM, Ho PM, Bradley SM, Sandhu A, et al. Postdischarge Bleeding After Percutaneous Coronary Intervention and Subsequent Mortality and Myocardial Infarction. Circulation: Cardiovascular Interventions. 2016; 9: e003519.","DOI":"10.1161\/CIRCINTERVENTIONS.115.003519"},{"key":"ref29","doi-asserted-by":"publisher","unstructured":"Moalem K, Baber U, Chandrasekhar J, Claessen BE, Sartori S, Aquino M, et al. Incidence, predictors, and outcomes of DAPT disruption due to non-compliance vs. bleeding after PCI: insights from the PARIS Registry. Clinical Research in Cardiology: Official Journal of the German Cardiac Society. 2019; 108: 643\u2013650.","DOI":"10.1007\/s00392-018-1392-2"},{"key":"ref30","doi-asserted-by":"publisher","unstructured":"Gulizia MM, Colivicchi F, Abrignani MG, Ambrosetti M, Aspromonte N, Barile G, et al. Consensus Document ANMCO\/ANCE\/ARCA\/GICR-IACPR\/GISE\/SICOA: Long-term Antiplatelet Therapy in Patients with Coronary Artery Disease. European Heart Journal Supplements: Journal of the European Society of Cardiology. 2018; 20: F1\u2013F74.","DOI":"10.1093\/eurheartj\/suy019"},{"key":"ref31","doi-asserted-by":"publisher","unstructured":"Jones WS, Mulder H, Wruck LM, Pencina MJ, Kripalani S, Mu\u00f1oz D, et al. Comparative Effectiveness of Aspirin Dosing in Cardiovascular Disease. The New England Journal of Medicine. 2021; 384: 1981\u20131990.","DOI":"10.1056\/NEJMoa2102137"},{"key":"ref32","doi-asserted-by":"publisher","unstructured":"Wang HY, Xu B, Song CX, Guan CD, Xie LH, Zhao YY, et al. Thrombotic vs. Bleeding Events of Interruption of Dual Antiplatelet Therapy within 12 Months among Patients with Stent-Driven High Ischemic Risk Definition following PCI. Journal of Interventional Cardiology. 2022; 2022: 3895205.","DOI":"10.1155\/2022\/3895205"},{"key":"ref33","doi-asserted-by":"publisher","unstructured":"Valgimigli M, Landi A. Bleeding risk should guide antithrombotic treatment after percutaneous coronary intervention: a Copernican revolution. European Heart Journal. 2024; 45: 3732\u20133734.","DOI":"10.1093\/eurheartj\/ehae542"},{"key":"ref34","doi-asserted-by":"publisher","unstructured":"Marquis-Gravel G, Dalgaard F, Jones AD, Lokhnygina Y, James SK, Harrington RA, et al. Post-Discharge Bleeding and Mortality Following Acute Coronary Syndromes With or Without PCI. Journal of the American College of Cardiology. 2020; 76: 162\u2013171.","DOI":"10.1016\/j.jacc.2020.05.031"},{"key":"ref35","doi-asserted-by":"publisher","unstructured":"Sorrentino S, Sartori S, Baber U, Claessen BE, Giustino G, Chandrasekhar J, et al. Bleeding Risk, Dual Antiplatelet Therapy Cessation, and Adverse Events After Percutaneous Coronary Intervention: The PARIS Registry. Circulation. Cardiovascular Interventions. 2020; 13: e008226.","DOI":"10.1161\/CIRCINTERVENTIONS.119.008226"},{"key":"ref36","doi-asserted-by":"publisher","unstructured":"Halvorsen S, Mehilli J, Cassese S, Hall TS, Abdelhamid M, Barbato E, et al. 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. European Heart Journal. 2022; 43: 3826\u20133924.","DOI":"10.1093\/eurheartj\/ehac270"},{"key":"ref37","doi-asserted-by":"publisher","unstructured":"Awtry EH, Loscalzo J. Aspirin. Circulation. 2000; 101: 1206\u20131218.","DOI":"10.1161\/01.cir.101.10.1206"},{"key":"ref38","unstructured":"Koski R, Kennedy B. Comparative Review of Oral P2Y12 Inhibitors. P & T: a Peer-reviewed Journal for Formulary Management. 2018; 43: 352\u2013357."},{"key":"ref39","unstructured":"Tikkinen KAO, Cartwright R, Gould MK, Naspro R, Novara G, Sandset PM, et al. EAU Guidelines on Thromboprophylaxis in Urological Surgery. EAU Guidelines Office: Arnhem, The Netherlands. 2022."},{"key":"ref40","doi-asserted-by":"publisher","unstructured":"Yee J, Kaide CG. Emergency Reversal of Anticoagulation. The Western Journal of Emergency Medicine. 2019; 20: 770\u2013783.","DOI":"10.5811\/westjem.2018.5.38235"},{"key":"ref41","doi-asserted-by":"publisher","unstructured":"Rogers AL, Allman RD, Fang X, Kindell LC, Nifong LW, Degner BC, et al. Thromboelastography-Platelet Mapping Allows Safe and Earlier Urgent Coronary Artery Bypass Grafting. The Annals of Thoracic Surgery. 2022; 113: 1119\u20131125.","DOI":"10.1016\/j.athoracsur.2021.07.068"},{"key":"ref42","doi-asserted-by":"publisher","unstructured":"Cao D, Amabile N, Chiarito M, Lee VT, Angiolillo DJ, Capodanno D, et al. Reversal and removal of oral antithrombotic drugs in patients with active or perceived imminent bleeding. European Heart Journal. 2023; 44: 1780\u20131794.","DOI":"10.1093\/eurheartj\/ehad119"},{"key":"ref43","doi-asserted-by":"publisher","unstructured":"Buchanan A, Newton P, Pehrsson S, Inghardt T, Antonsson T, Svensson P, et al. Structural and functional characterization of a specific antidote for ticagrelor. Blood. 2015; 125: 3484\u20133490.","DOI":"10.1182\/blood-2015-01-622928"},{"key":"ref44","doi-asserted-by":"publisher","unstructured":"Bhatt DL, Pollack CV, Mazer CD, Angiolillo DJ, Steg PG, James SK, et al. Bentracimab for Ticagrelor Reversal in Patients Undergoing Urgent Surgery. NEJM Evidence. 2022; 1: EVIDoa2100047.","DOI":"10.1056\/EVIDoa2100047"},{"key":"ref45","unstructured":"Ticagrelor antidote safely, effectively restores platelet function and treats bleeding. News release. American College of Cardiology. March 29, 2025. Available at: https:\/\/www.acc.org\/About-ACC\/Press-Releases\/2025\/03\/29\/15\/23\/Ticagrelor-Antidote-Safely (Accessed: 29 March 2025)."},{"key":"ref46","doi-asserted-by":"publisher","unstructured":"Andersen LK, Hvas AM, Hvas CL. Effect of Desmopressin on Platelet Dysfunction During Antiplatelet Therapy: A Systematic Review. Neurocritical Care. 2021; 34: 1026\u20131046.","DOI":"10.1007\/s12028-020-01055-6"},{"key":"ref47","doi-asserted-by":"publisher","unstructured":"Frontera JA, Lewin JJ, 3rd, Rabinstein AA, Aisiku IP, Alexandrov AW, Cook AM, et al. Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage: A Statement for Healthcare Professionals from the Neurocritical Care Society and Society of Critical Care Medicine. Neurocritical Care. 2016; 24: 6\u201346.","DOI":"10.1007\/s12028-015-0222-x"},{"key":"ref48","doi-asserted-by":"publisher","unstructured":"Prasad N, Meyyappan J, Yadav DK, Yadav B, Kushwaha R, Patel M, et al. Randomized Double-Blind Placebo-Controlled Trial of Desmopressin for Post-Kidney Biopsy Bleeding. Kidney International Reports. 2025; 10: 2436\u20132445.","DOI":"10.1016\/j.ekir.2025.04.019"},{"key":"ref49","doi-asserted-by":"publisher","unstructured":"Godier A, Albaladejo P, On Perioperative Haemostasis Gihp Group TFWG. Management of Bleeding Events Associated with Antiplatelet Therapy: Evidence, Uncertainties and Pitfalls. Journal of Clinical Medicine. 2020; 9: 2318.","DOI":"10.3390\/jcm9072318"},{"key":"ref50","doi-asserted-by":"publisher","unstructured":"Zafar MU, Santos-Gallego C, Vorchheimer DA, Viles-Gonzalez JF, Elmariah S, Giannarelli C, et al. Platelet function normalization after a prasugrel loading-dose: time-dependent effect of platelet supplementation. Journal of Thrombosis and Haemostasis: JTH. 2013; 11: 100\u2013106.","DOI":"10.1111\/jth.12058"},{"key":"ref51","doi-asserted-by":"publisher","unstructured":"Bertling A, Fender AC, Sch\u00fcngel L, Rumpf M, Mergemeier K, Gei\u00dfler G, et al. Reversibility of platelet P2Y12 inhibition by platelet supplementation: ex vivo and in vitro comparisons of prasugrel, clopidogrel and ticagrelor. Journal of Thrombosis and Haemostasis: JTH. 2018; 16: 1089\u20131098.","DOI":"10.1111\/jth.14014"},{"key":"ref52","doi-asserted-by":"publisher","unstructured":"Vilahur G, Choi BG, Zafar MU, Viles-Gonzalez JF, Vorchheimer DA, Fuster V, et al. Normalization of platelet reactivity in clopidogrel-treated subjects. Journal of Thrombosis and Haemostasis: JTH. 2007; 5: 82\u201390.","DOI":"10.1111\/j.1538-7836.2006.02245.x"},{"key":"ref53","doi-asserted-by":"publisher","unstructured":"Baharoglu MI, Cordonnier C, Al-Shahi Salman R, de Gans K, Koopman MM, Brand A, et al. Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomised, open-label, phase 3 trial. Lancet (London, England). 2016; 387: 2605\u20132613.","DOI":"10.1016\/S0140-6736(16)30392-0"},{"key":"ref54","doi-asserted-by":"publisher","unstructured":"Zakko L, Rustagi T, Douglas M, Laine L. No Benefit From Platelet Transfusion for Gastrointestinal Bleeding in Patients Taking Antiplatelet Agents. Clinical Gastroenterology and Hepatology: the Official Clinical Practice Journal of the American Gastroenterological Association. 2017; 15: 46\u201352.","DOI":"10.1016\/j.cgh.2016.07.017"},{"key":"ref55","doi-asserted-by":"publisher","unstructured":"Ducrocq G, Gonzalez-Juanatey JR, Puymirat E, Lemesle G, Cachanado M, Durand-Zaleski I, et al. Effect of a Restrictive vs Liberal Blood Transfusion Strategy on Major Cardiovascular Events Among Patients With Acute Myocardial Infarction and Anemia: The REALITY Randomized Clinical Trial. JAMA. 2021; 325: 552\u2013560.","DOI":"10.1001\/jama.2021.0135"},{"key":"ref56","doi-asserted-by":"publisher","unstructured":"Goel R, Ness PM, Takemoto CM, Krishnamurti L, King KE, Tobian AAR. Platelet transfusions in platelet consumptive disorders are associated with arterial thrombosis and in-hospital mortality. 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Pediatric Nephrology (Berlin, Germany). 2023; 38: 2549\u20132562.","DOI":"10.1007\/s00467-022-05746-4"},{"key":"ref66","doi-asserted-by":"publisher","unstructured":"Barocas DA, Lotan Y, Matulewicz RS, Raman JD, Westerman ME, Kirkby E, et al. Updates to Microhematuria: AUA\/SUFU Guideline (2025). The Journal of Urology. 2025; 213: 547\u2013557.","DOI":"10.1097\/JU.0000000000004490"},{"key":"ref67","doi-asserted-by":"crossref","unstructured":"Culclasure TF, Bray VJ, Hasbargen JA. The significance of hematuria in the anticoagulated patient. Archives of Internal Medicine. 1994; 154: 649\u2013652.","DOI":"10.1001\/archinte.1994.00420060075008"},{"key":"ref68","unstructured":"National Institute for Health and Care Excellence (NICE). Suspected cancer: recognition and referral [NG12]. NICE: London. 2021."},{"key":"ref69","unstructured":"Leslie SW, Chargui S, Stormont G. Transurethral Resection of the Prostate. In StatPearls [Internet]. StatPearls Publishing: Treasure Island (FL). 2025."},{"key":"ref70","unstructured":"Rodr\u00edguez-Patr\u00f3n Rodr\u00edguez R, Sanz Mayayo E, G\u00f3mez Garc\u00eda I, Blazquez Sanchez J, Sanchez Corral J, Briones Mardones G, et al. Hypogastric artery embolization as a palliative treatment for bleeding secondary to intractable bladder or prostate disease. Archivos Espanoles de Urologia. 2003; 56: 111\u2013118. (In Spanish)"},{"key":"ref71","doi-asserted-by":"publisher","unstructured":"Deng L, Li C, He Q, Huang C, Chen Q, Zhang S, et al. Superselective Prostate Artery Embolization for Treatment of Severe Haematuria Secondary to Rapid Progression of Treatment-Induced Neuroendocrine Prostate Cancer: A Case Report. OncoTargets and Therapy. 2022; 15: 67\u201375.","DOI":"10.2147\/OTT.S345193"},{"key":"ref72","doi-asserted-by":"publisher","unstructured":"Ogita M, Kawamori J, Yamashita H, Nakagawa K. Palliative radiotherapy for gross hematuria in patients with advanced cancer. 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Lancet (London, England). 2017; 389: 1025\u20131034.","DOI":"10.1016\/S0140-6736(17)30397-5"},{"key":"ref83","doi-asserted-by":"publisher","unstructured":"Yeh RW, Secemsky EA, Kereiakes DJ, Normand SLT, Gershlick AH, Cohen DJ, et al. Development and Validation of a Prediction Rule for Benefit and Harm of Dual Antiplatelet Therapy Beyond 1 Year After Percutaneous Coronary Intervention. JAMA. 2016; 315: 1735\u20131749.","DOI":"10.1001\/jama.2016.3775"},{"key":"ref84","doi-asserted-by":"publisher","unstructured":"Kang J, Yun J, Park KW, Park M, Park S, Hwang D, et al. Long-term outcomes of high bleeding risk patients undergoing percutaneous coronary intervention: a Korean nationwide registry. European Heart Journal. 2024; 45: 3721\u20133731.","DOI":"10.1093\/eurheartj\/ehae462"},{"key":"ref85","doi-asserted-by":"publisher","unstructured":"Costa F, Van Klaveren D, Feres F, James S, R\u00e4ber L, Pilgrim T, et al. 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JAMA. 2019; 321: 2428\u20132437.","DOI":"10.1001\/jama.2019.8146"},{"key":"ref90","doi-asserted-by":"publisher","unstructured":"Sibbing D, Aradi D, Jacobshagen C, Gross L, Trenk D, Geisler T, et al. Guided de-escalation of antiplatelet treatment in patients with acute coronary syndrome undergoing percutaneous coronary intervention (TROPICAL-ACS): a randomised, open-label, multicentre trial. Lancet (London, England). 2017; 390: 1747\u20131757.","DOI":"10.1016\/S0140-6736(17)32155-4"},{"key":"ref91","doi-asserted-by":"publisher","unstructured":"van Schie RMF, Verhoef TI, Boejharat SB, Schalekamp T, Wessels JAM, le Cessie S, et al. Evaluation of the effect of statin use on the acenocoumarol and phenprocoumon maintenance dose. Drug Metabolism and Drug Interactions. 2012; 27: 229\u2013234.","DOI":"10.1515\/dmdi-2012-0024"},{"key":"ref92","doi-asserted-by":"publisher","unstructured":"Ehrlich A, Fuder H, Hartmann M, Wieckhorst G, Timmer W, Huber R, et al. 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