Visible haematuria in an adult carries a meaningful risk of urothelial cancer and is an established indication for cystoscopy and upper tract imaging, whatever the urine tests show. Anticoagulants do not explain it away: bleeding on anticoagulation often unmasks an underlying lesion.
Non-visible haematuria is lower risk and is increasingly stratified by age, smoking history and other factors. Confirm it on repeat testing and exclude infection before referral.
- Refer adults with visible haematuria for cystoscopy and upper tract imaging.
- Do not attribute haematuria to anticoagulation without investigation.
- Confirm non-visible haematuria on repeat dipstick or microscopy and exclude infection.
- Ask about smoking and occupational chemical exposure, both bladder cancer risks.
Why it matters
A reassuring test or an obvious explanation is the commonest reason a bladder cancer diagnosis is delayed.
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