BACKGROUND: Hospitalized medically ill patients receiving antithrombotic medications experience increased risk of bleeding. We examined antithrombotic use, bleeding rates, and associated risk factors at 30 days post discharge. METHODS: This retrospective database analysis included nonsurgical patients aged ≥40 years hospitalized for ≥2 days during 2005 to 2009. Previously cited, validated International Classification of Diseases, Ninth Revision, Clinical Modification codes for major bleeding were used to define clinically relevant bleeding. RESULTS: Of the 327,578 patients, 9.1% received antithrombotic medications, of which 3.7% were anticoagulants. Rates of major and minor bleeding were 1.8% and 7.1%, respectively. Preindex gastroduodenal ulcer, thromboembolic stroke, blood dyscrasias, liver disease, and rehospitalization were the strongest predictors of major bleeding. Other risk factors included increasing age, male gender, and hospital stay of ≥3 days. CONCLUSIONS: Careful consideration of these demonstrated bleed-associated comorbidities before initiating anticoagulation or combining antithrombotic medications in medically ill patients may improve strategies for prevention of postdischarge thromboembolism.
BACKGROUND: Hospitalized medically ill patients receiving antithrombotic medications experience increased risk of bleeding. We examined antithrombotic use, bleeding rates, and associated risk factors at 30 days post discharge. METHODS: This retrospective database analysis included nonsurgical patients aged ≥40 years hospitalized for ≥2 days during 2005 to 2009. Previously cited, validated International Classification of Diseases, Ninth Revision, Clinical Modification codes for major bleeding were used to define clinically relevant bleeding. RESULTS: Of the 327,578 patients, 9.1% received antithrombotic medications, of which 3.7% were anticoagulants. Rates of major and minor bleeding were 1.8% and 7.1%, respectively. Preindex gastroduodenal ulcer, thromboembolic stroke, blood dyscrasias, liver disease, and rehospitalization were the strongest predictors of major bleeding. Other risk factors included increasing age, male gender, and hospital stay of ≥3 days. CONCLUSIONS: Careful consideration of these demonstrated bleed-associated comorbidities before initiating anticoagulation or combining antithrombotic medications in medically ill patients may improve strategies for prevention of postdischarge thromboembolism.
Authors: Andrea J Darzi; Samer G Karam; Rana Charide; Itziar Etxeandia-Ikobaltzeta; Mary Cushman; Michael K Gould; Lawrence Mbuagbaw; Frederick A Spencer; Alex C Spyropoulos; Michael B Streiff; Scott Woller; Neil A Zakai; Federico Germini; Marta Rigoni; Arnav Agarwal; Rami Z Morsi; Alfonso Iorio; Elie A Akl; Holger J Schünemann Journal: Blood Date: 2020-05-14 Impact factor: 22.113
Authors: Scott Kaatz; Charles E Mahan; Asaad Nakhle; Kulothungan Gunasekaran; Mahmoud Ali; Robert Lavender; David G Paje Journal: Curr Cardiol Rep Date: 2017-10-24 Impact factor: 2.931
Authors: Allison E Burnett; Charles E Mahan; Sara R Vazquez; Lynn B Oertel; David A Garcia; Jack Ansell Journal: J Thromb Thrombolysis Date: 2016-01 Impact factor: 2.300