Endalkachew Admassie1, Leanne Chalmers2, Luke R Bereznicki3. 1. Division of Pharmacy, School of Medicine, University of Tasmania, Private Bag 26, Hobart, Tasmania, 7001, Australia. Endalkachew.alamneh@utas.edu.au. 2. School of Pharmacy, Curtin University, Perth, Western Australia, Australia. 3. Division of Pharmacy, School of Medicine, University of Tasmania, Private Bag 26, Hobart, Tasmania, 7001, Australia.
Abstract
PURPOSE: Limited data are available from the Australian setting regarding bleeding in patients with atrial fibrillation (AF) receiving antithrombotic therapy. We aimed to investigate the incidence of hospital admissions due to bleeding and factors associated with bleeding in patients with AF who received antithrombotic therapy. METHODS: A retrospective cohort study was conducted involving all patients with AF admitted to the Royal Hobart Hospital, Tasmania, Australia, between January 2011 and July 2015. Bleeding rates were calculated per 100 patient-years (PY) of follow-up, and multivariable modelling was used to identify predictors of bleeding. RESULTS: Of 2202 patients receiving antithrombotic therapy, 113 presented to the hospital with a major or minor bleeding event. These patients were older, had higher stroke and bleeding risk scores and were more often treated with warfarin and multiple antithrombotic therapies than patients who did not experience bleeding. The combined incidence of major and minor bleeding was significantly higher in warfarin- versus direct-acting oral anticoagulants (DOAC)- and antiplatelet-treated patients (4.1 vs 3.0 vs 1.2 per 100 PY, respectively; p = 0.002). Similarly, the rate of major bleeding was higher in patients who received warfarin than in the DOAC and antiplatelet cohorts (2.4 vs 0.4 vs 0.6 per 100 PY, respectively; p = 0.001). In multivariate analysis, increasing age, prior bleeding, warfarin and multiple antithrombotic therapies were independently associated with bleeding. CONCLUSION: The overall rate of bleeding in this cohort was low relative to similar observational studies. The rate of major bleeding was higher in patients prescribed warfarin compared to DOACs, with a similar rate of major bleeding for DOACs and antiplatelet agents. Our findings suggest potential to strategies to reduce bleeding include using DOACs in preference to warfarin, and avoiding multiple antithrombotic therapies in patients with AF.
PURPOSE: Limited data are available from the Australian setting regarding bleeding in patients with atrial fibrillation (AF) receiving antithrombotic therapy. We aimed to investigate the incidence of hospital admissions due to bleeding and factors associated with bleeding in patients with AF who received antithrombotic therapy. METHODS: A retrospective cohort study was conducted involving all patients with AF admitted to the Royal Hobart Hospital, Tasmania, Australia, between January 2011 and July 2015. Bleeding rates were calculated per 100 patient-years (PY) of follow-up, and multivariable modelling was used to identify predictors of bleeding. RESULTS: Of 2202 patients receiving antithrombotic therapy, 113 presented to the hospital with a major or minor bleeding event. These patients were older, had higher stroke and bleeding risk scores and were more often treated with warfarin and multiple antithrombotic therapies than patients who did not experience bleeding. The combined incidence of major and minor bleeding was significantly higher in warfarin- versus direct-acting oral anticoagulants (DOAC)- and antiplatelet-treated patients (4.1 vs 3.0 vs 1.2 per 100 PY, respectively; p = 0.002). Similarly, the rate of major bleeding was higher in patients who received warfarin than in the DOAC and antiplatelet cohorts (2.4 vs 0.4 vs 0.6 per 100 PY, respectively; p = 0.001). In multivariate analysis, increasing age, prior bleeding, warfarin and multiple antithrombotic therapies were independently associated with bleeding. CONCLUSION: The overall rate of bleeding in this cohort was low relative to similar observational studies. The rate of major bleeding was higher in patients prescribed warfarin compared to DOACs, with a similar rate of major bleeding for DOACs and antiplatelet agents. Our findings suggest potential to strategies to reduce bleeding include using DOACs in preference to warfarin, and avoiding multiple antithrombotic therapies in patients with AF.
Authors: Nicole L Pratt; Emmae N Ramsay; Gillian E Caughey; Sepehr Shakib; Elizabeth E Roughead Journal: Med J Aust Date: 2016-02-15 Impact factor: 7.738
Authors: G Palareti; N Leali; S Coccheri; M Poggi; C Manotti; A D'Angelo; V Pengo; N Erba; M Moia; N Ciavarella; G Devoto; M Berrettini; S Musolesi Journal: Lancet Date: 1996-08-17 Impact factor: 79.321
Authors: Jonas Bjerring Olesen; Gregory Y H Lip; Jesper Lindhardsen; Deirdre A Lane; Ole Ahlehoff; Morten Lock Hansen; Jakob Raunsø; Janne Schurmann Tolstrup; Peter Riis Hansen; Gunnar Hilmar Gislason; Christian Torp-Pedersen Journal: Thromb Haemost Date: 2011-07-20 Impact factor: 5.249
Authors: Claes Held; Elaine M Hylek; John H Alexander; Michael Hanna; Renato D Lopes; Daniel M Wojdyla; Laine Thomas; Hussein Al-Khalidi; Marco Alings; Dennis Xavier; Jack Ansell; Shinya Goto; Witold Ruzyllo; Mårten Rosenqvist; Freek W A Verheugt; Jun Zhu; Christopher B Granger; Lars Wallentin Journal: Eur Heart J Date: 2014-12-12 Impact factor: 29.983
Authors: Torben Bjerregaard Larsen; Anders Gorst-Rasmussen; Lars Hvilsted Rasmussen; Flemming Skjøth; Mary Rosenzweig; Gregory Y H Lip Journal: Am J Med Date: 2014-02-13 Impact factor: 4.965
Authors: Tara Gomes; Muhammad M Mamdani; Anne M Holbrook; J Michael Paterson; Chelsea Hellings; David N Juurlink Journal: CMAJ Date: 2012-11-26 Impact factor: 8.262
Authors: Renate B Schnabel; Xiaoyan Yin; Philimon Gona; Martin G Larson; Alexa S Beiser; David D McManus; Christopher Newton-Cheh; Steven A Lubitz; Jared W Magnani; Patrick T Ellinor; Sudha Seshadri; Philip A Wolf; Ramachandran S Vasan; Emelia J Benjamin; Daniel Levy Journal: Lancet Date: 2015-05-07 Impact factor: 79.321