Pak-Hei Chan1, Wen-Hua Li1, Jo-Jo Hai1, Koon-Ho Chan2, Hung-Fat Tse1, Bernard Man-Yung Cheung3, Esther W Chan4, Ian C K Wong4, Wai-Keung Leung5, Ivan Fan-Ngai Hung5, Gregory Y H Lip6, Chung-Wah Siu7. 1. Division of Cardiology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China. 2. Division of Neurology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China. 3. Division of Clinical Pharmacology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China. 4. Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong SAR, China. 5. Division of Gastroenterology and Hepatology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China. 6. University of Birmingham, Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK. 7. Division of Cardiology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China cwdsiu@hku.hk.
Abstract
AIMS: Gastrointestinal haemorrhage is a common complication of antiplatelet and anticoagulation therapy. The aim of this study is to evaluate the impact of warfarin with different time in therapeutic ranges (TTRs) on the risk of major gastrointestinal haemorrhage in atrial fibrillation (AF) patients compared with aspirin. METHODS AND RESULTS: In this observational study, 5426 Chinese AF patients (77.7 ± 10.7 years, female: 53.1%) with a CHA2DS2-VASc score of ≥1 were included in the final analysis: of which, 3832 patients (70.6%) were taking aspirin and 1594 patients (29.4%) were taking warfarin, whereas the remaining patients did not receive any anticoagulation. The mean baseline HAS-BLED score was 2.22 ± 0.93. Among those on warfarin, the median TTR was 39.2%. After a mean follow-up of 3.6 years (19 777 patient-years), 262 patients developed a gastrointestinal haemorrhage requiring transfusion (4.83%), with an annual incidence of 1.32%/year. Annual incidences of gastrointestinal haemorrhage requiring transfusion among patients on aspirin and warfarin were 1.53%/year and 1.00%/year, respectively. For patients on warfarin, the incidence of gastrointestinal haemorrhage increased progressively with higher HAS-BLED scores, from 0.93%/year for those with a HAS-BLED score of ≤1 to 1.68%/year for those with a HAS-BLED score of ≥3, and decreased progressively with an increasing TTR from 1.69%/year for patients in the lowest quartile of TTR to only 0.51%/year for those in the top quartile. CONCLUSION: Aspirin is overall associated with a higher risk of gastrointestinal haemorrhage compared with warfarin, despite the suboptimal TTR in the study population. For patients on warfarin, a HAS-BLED score at baseline prior to commencing anticoagulation positively correlates with gastrointestinal haemorrhage. A poor TTR was associated with a higher risk of gastrointestinal haemorrhage. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Gastrointestinal haemorrhage is a common complication of antiplatelet and anticoagulation therapy. The aim of this study is to evaluate the impact of warfarin with different time in therapeutic ranges (TTRs) on the risk of major gastrointestinal haemorrhage in atrial fibrillation (AF) patients compared with aspirin. METHODS AND RESULTS: In this observational study, 5426 Chinese AFpatients (77.7 ± 10.7 years, female: 53.1%) with a CHA2DS2-VASc score of ≥1 were included in the final analysis: of which, 3832 patients (70.6%) were taking aspirin and 1594 patients (29.4%) were taking warfarin, whereas the remaining patients did not receive any anticoagulation. The mean baseline HAS-BLED score was 2.22 ± 0.93. Among those on warfarin, the median TTR was 39.2%. After a mean follow-up of 3.6 years (19 777 patient-years), 262 patients developed a gastrointestinal haemorrhage requiring transfusion (4.83%), with an annual incidence of 1.32%/year. Annual incidences of gastrointestinal haemorrhage requiring transfusion among patients on aspirin and warfarin were 1.53%/year and 1.00%/year, respectively. For patients on warfarin, the incidence of gastrointestinal haemorrhage increased progressively with higher HAS-BLED scores, from 0.93%/year for those with a HAS-BLED score of ≤1 to 1.68%/year for those with a HAS-BLED score of ≥3, and decreased progressively with an increasing TTR from 1.69%/year for patients in the lowest quartile of TTR to only 0.51%/year for those in the top quartile. CONCLUSION:Aspirin is overall associated with a higher risk of gastrointestinal haemorrhage compared with warfarin, despite the suboptimal TTR in the study population. For patients on warfarin, a HAS-BLED score at baseline prior to commencing anticoagulation positively correlates with gastrointestinal haemorrhage. A poor TTR was associated with a higher risk of gastrointestinal haemorrhage. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Judit Papp; Endre Zima; Ramon Bover; Rasa Karaliute; Andrea Rossi; Catherine Szymanski; Rossella Troccoli; Jonas Schneider; Morten Wang Fagerland; A John Camm; Dan Atar Journal: Eur Heart J Cardiovasc Pharmacother Date: 2017-07-01
Authors: Mi Zhou; Esther W Chan; Jo Jo Hai; Chun Ka Wong; Yuk Ming Lau; Duo Huang; Cheung Chi Lam; Chor Cheung Frankie Tam; Yiu Tung Anthony Wong; See Yue Arthur Yung; Ki Wan Kelvin Chan; Yingqing Feng; Ning Tan; Ji-Yan Chen; Chi Yui Yung; Kwok Lun Lee; Chun Wai Choi; Ho Lam; Andrew Ng; Katherine Fan; Man Hong Jim; Kai Hang Yiu; Bryan P Yan; Chung Wah Siu Journal: BMJ Open Date: 2020-09-25 Impact factor: 2.692