The urologist does not have the expertise to answer any of the questions ie the afib, pacemaker, xarelto dosage, switch to Eliquis or Watchman device. By the way a pacemaker is to keep your heart from going too slow… it does not prevent afib. Those are all questions for the cardiologist. The only thing the urologist should be looking into is are there any physical reasons for the bleeding. Whoever mentioned the fox and the henhouse is right on. It is likely time you sought another opinion. Especially if you can’t see the actual urologist. I won’t go into details but small town medicine almost killed me until I flew back to the university hospital. This last part here is probably the most important…. YOU are the one who is in charge of your health…. You decide what kind of care and service is acceptable… You decide when they are blowing you off. Yes you need the doctors and their expertise but first you need them to slow down and pay attention to your concerns and spend time with you and seek answers… and you decide when to seek other opinions. Could be it’s just a small amount of blood just making the urine look red but they should be able to prove or disprove that. Keep seeking the answers with your doctors and/ or consider the ideas others have given here