Should patients with non-muscle-invasive bladder cancer discontinue fibrin clot inhibitors during bacille Calmette–Guérin?

Niyati Lobo, Patrick J. Hensley, Kelly K. Bree, Graciela M. Nogueras-Gonzalez, Neema Navai, Colin P. Dinney, Ashish M. Kamat

Research output: Contribution to journalArticlepeer-review


Objective: To determine the impact of fibrin clot inhibitor (FCI) use on oncological outcomes in a large contemporary cohort of patients with non-muscle-invasive bladder cancer (NMIBC) treated with adequate bacille Calmette–Guérin (BCG). Patients and Methods: We performed an Institutional Review Board-approved review of patients with NMIBC treated with adequate intravesical BCG, at our institution between 2000 and 2018. FCI use at the time of BCG therapy was recorded for each patient. Patients were stratified according to use of FCI medication. Recurrence- and progression-free survival were analysed using Kaplan–Meier methods and Cox proportional hazard models. Results: Overall, 226 of 526 patients (43.0%) used a FCI: aspirin (205), clopidogrel (38), warfarin (18) and novel oral anticoagulant (NOAC; seven). The use of FCIs did not adversely affect either recurrence- or progression-free survival (P = 0.385 and P = 0.131, respectively). These results did not change when the impact of aspirin, clopidogrel or warfarin/NOAC use on recurrence and progression was evaluated separately. On multivariate analysis, FCI use was neither associated with tumour recurrence nor progression. Conclusion: The use of FCIs was not associated with adverse oncological outcomes in a large contemporary cohort of patients receiving adequate intravesical BCG for NMIBC. Based on these results, FCIs may be safely continued during BCG immunotherapy.

Original languageEnglish
Pages (from-to)463-469
Number of pages7
JournalBJU International
Issue number4
StatePublished - Oct 2022

Bibliographical note

Funding Information:
The authors report the following financial interests: Colin P. Dinney: National Cancer Institutes and University of East Finland Faculty of Health Sciences research funding; grant and personal fees from FKD Therapies; creator of intellectual property owned by UT/MD Anderson Cancer Center related to the use of genetic alterations as a predictive biomarker for response to Nadofaragene firadenovac. Ashish M. Kamat is a consultant or advisory board member for Abbott Molecular, Arquer Diagnostics, ArTara Therapeutics, Asieris Pharmaceuticals, AstraZeneca, BioClin Therapeutics, Bristol Myers Squibb, Cepheid, Cold Genesys, Eisai, Engene, Ferring Pharmaceuticals, FerGene, Imagine Pharma, Janssen, MDxHealth, Medac, Merck, Pfizer, Photocure, ProTara Therapeutics, Roviant Sciences, Seattle Genetics, Sessen Bio, Theralase Technologies, TMC Innovation and US Biotest. A.M.K. has received grants and/or research support from Adolor Corporation, Bristol Myers Squibb, FKD Industries, Heat Biologics, Merck, Photocure, SWOG/NIH, Specialized Programs of Research Excellence (SPORE) and AIBCCR. A.M.K. also holds the patent for Cytokine Predictors of Response to Intravesical Therapy (CyPRIT) joint with UT MD Anderson Cancer Center.

Funding Information:
This research was supported by the Wayne B. Duddlesten Professorship in Cancer Research and the Raymond and Maria Floyd Bladder Cancer Research Foundation to Ashish M. Kamat, the Urology Foundation Fulbright Scholar Award to Niyati Lobo and a Cancer Center Support Grant (NCI Grant P30 CA016672) to Graciela M. Nogueras‐Gonzalez.

Publisher Copyright:
© 2021 The Authors BJU International © 2021 BJU International.


  • #BladderCancer
  • #Urology
  • #blcsm
  • #uroonc
  • aspirin
  • bacille Calmette–Guérin
  • bladder cancer
  • clopidogrel
  • fibrin clot inhibitor
  • novel oral anticoagulant
  • warfarin

ASJC Scopus subject areas

  • Urology


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