Prediagnostic use of anticoagulant treatment in patients with renal cell carcinoma: Impact on stage distribution and postoperative prognosis

BACKGROUND AND OBJECTIVES: This study examined the association between prediagnostic anticoagulant use and stage at diagnosis, surgical outcomes, and mortality in patients with renal cell carcinoma (RCC). METHODS: In a nationwide register-based Danish cohort study, we included RCC patients undergoing partial or radical nephrectomy in Denmark in 2009-2020. We compared stage distribution, readmission and reoperation rates, length of hospital stay (LOS), and mortality by anticoagulant use status (current, former, and non-users), using regression analyses and cumulative incidence rates. RESULTS: Among 5730 RCC patients, 21.0% were current and 11.4% former anticoagulant users. At diagnosis, the odds of having higher stage (stage III/ IV) was slightly lower among anticoagulant users (adjusted ORs were 0.90 [95% CI 0.71-1.00] for current users and 0.85 [95% CI 0.73-0.90] for former users). The cumulative 30-day readmission rate was higher in current (18.5%) and former users (19.2%) than non-users (13.5%), while LOS and reoperation rates were similar. Current users had slightly higher 90-day mortality (adjusted hazard ratio [aHR] 1.10 [95% CI 0.65-1.88]), but lower one-year mortality (aHR 0.81 [95% CI 0.60-1.07]) compared with non-users. Former users had slightly higher one-year mortality (aHR 1.12 [95% CI 0.82-1.54]). CONCLUSIONS: RCC patients with prediagnostic anticoagulant use had higher 30-day readmission rates but otherwise comparable perioperative outcomes and mortality to non-users, suggesting that prediagnostic anticoagulant use is not, in itself, a strong marker of poorer surgical prognosis.