Cecilia Becattini1, Laura Franco2, Jan Beyer-Westendorf3, Luca Masotti4, Cinzia Nitti5, Simone Vanni6, Giorgia Manina7, Sergio Cattinelli8, Roberto Cappelli9, Rodolfo Sbrojavacca10, Fulvio Pomero11, Sandra Marten3, Giancarlo Agnelli2. 1. Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Italy. Electronic address: cecilia.becattini@unipg.it. 2. Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Italy. 3. Center for Vascular Medicine, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany. 4. Internal Medicine, Santa Maria Nuova Hospital, Firenze, Italy. 5. Emergency Medicine, Ospedali Riuniti Umberto I - Lancisi- Salesi, Ancona, Italy. 6. Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy. 7. Emergency Medicine, Ospedale Maggiore, Lodi, Italy. 8. Emergency Medicine, Ospedale Cattinara, Trieste, Italy. 9. Internal Medicine, University of Siena, Italy. 10. Emergency Medicine, Santa Maria della Misericordia Hospital, Udine, Italy. 11. Internal Medicine, Santa Croce Hospital, Cuneo, Italy.
Abstract
BACKGROUND: Limited data are available on major bleeding (MB) occurring during treatment with vitamin K (VKAs) or direct oral anticoagulants (DOACs) outside clinical trials. METHODS: Patients hospitalized for MB while on treatment with VKAs or DOACs were included in a multicenter study to compare clinical presentation, management and outcome of bleeding. The primary study outcome was death at 30days. RESULTS: Between September 2013 and September 2015, 806 patients were included in the study, 76% on VKAs and 24% on DOACs. MB was an intracranial hemorrhage in 51% and 21% patients on VKAs or DOACs, respectively (Odds Ratio [OR] 3.79; 95% confidence interval [CI] 2.59-5.54) a gastrointestinal bleeding in 46% and 25% patients on DOACs and VKAs, respectively (OR 2.62; 95% CI 1.87-3.68). Death at 30days occurred in 130 patients (16%), 18% and 9% of VKA and DOAC patients (HR 1.95; 95% CI 1.19-3.22, p=0.008). The rate of death at 30days was similar in VKA and DOAC patients with intracranial hemorrhage (26% and 24%; HR 1.05, 95% CI 0.54-2.02) and gastrointestinal bleeding (11% and 7%; HR 1.46, 95% CI 0.57-3.74) and higher in VKA than DOAC patients with other MBs (10% and 3%; HR 3.42, 95% CI 0.78-15.03). CONCLUSIONS: Admission for ICH is less frequent for DOAC patients compared with VKA patients. Admission for gastrointestinal MB is more frequent for DOAC as compared to VKA patients. Mortality seems lower in patients with MBs while on DOACs than VKAs but this finding varies across different types of MBs.
BACKGROUND: Limited data are available on major bleeding (MB) occurring during treatment with vitamin K (VKAs) or direct oral anticoagulants (DOACs) outside clinical trials. METHODS:Patients hospitalized for MB while on treatment with VKAs or DOACs were included in a multicenter study to compare clinical presentation, management and outcome of bleeding. The primary study outcome was death at 30days. RESULTS: Between September 2013 and September 2015, 806 patients were included in the study, 76% on VKAs and 24% on DOACs. MB was an intracranial hemorrhage in 51% and 21% patients on VKAs or DOACs, respectively (Odds Ratio [OR] 3.79; 95% confidence interval [CI] 2.59-5.54) a gastrointestinal bleeding in 46% and 25% patients on DOACs and VKAs, respectively (OR 2.62; 95% CI 1.87-3.68). Death at 30days occurred in 130 patients (16%), 18% and 9% of VKA and DOACpatients (HR 1.95; 95% CI 1.19-3.22, p=0.008). The rate of death at 30days was similar in VKA and DOACpatients with intracranial hemorrhage (26% and 24%; HR 1.05, 95% CI 0.54-2.02) and gastrointestinal bleeding (11% and 7%; HR 1.46, 95% CI 0.57-3.74) and higher in VKA than DOACpatients with other MBs (10% and 3%; HR 3.42, 95% CI 0.78-15.03). CONCLUSIONS: Admission for ICH is less frequent for DOACpatients compared with VKA patients. Admission for gastrointestinal MB is more frequent for DOAC as compared to VKA patients. Mortality seems lower in patients with MBs while on DOACs than VKAs but this finding varies across different types of MBs.
Authors: Avi Leader; Eva N Hamulyák; Brian J Carney; Maya Avrahami; Jelijn J Knip; Shira Rozenblatt; Ludo F M Beenen; Shlomit Yust-Katz; Oded Icht; Michiel Coppens; Pia Raanani; Saskia Middeldorp; Harry R Büller; Jeffrey I Zwicker; Galia Spectre Journal: Blood Adv Date: 2020-12-22
Authors: Edelgard Lindhoff-Last; Eva Herrmann; Simone Lindau; Stavros Konstantinides; Oliver Grottke; Ulrike Nowak-Goettl; Jessica Lucks; Barbara Zydek; Christian von Heymann; Ingvild Birschmann; Ariane Sümnig; Jan Beyer-Westendorf; Sebastian Schellong; Patrick Meybohm; Andreas Greinacher Journal: Dtsch Arztebl Int Date: 2020-05-01 Impact factor: 5.594
Authors: Walter Bialkowski; Sylvia Tan; Alan E Mast; Joseph E Kiss; Daryl Kor; Jerome Gottschall; Yanyun Wu; Nareg Roubinian; Darrell Triulzi; Steve Kleinman; Young Choi; Donald Brambilla; Ann Zimrin Journal: Thromb Res Date: 2019-11-25 Impact factor: 3.944
Authors: Christopher Beynon; Steffen Brenner; Alexander Younsi; Timolaos Rizos; Jan-Oliver Neumann; Johannes Pfaff; Andreas W Unterberg Journal: Neurocrit Care Date: 2019-04 Impact factor: 3.210