Jan-Erik Guelker1, Dimitrios Ilousis2, Knut Kröger3, Frans Santosa4, Bernd Kowall5, Andreas Stang6. 1. Clinic of Cardiology, St.-Johannes-Hospital, Dortmund, Germany. 2. Clinic of Cardiology, HELIOS Klinik Krefeld, Germany. 3. Clinic of Vascular Medicine, HELIOS Klinik Krefeld, Germany. Electronic address: knut.kroeger@helios-kliniken.de. 4. Medical Faculty Universitas Pembangunan Nasional Veteran Jakarta, Indonesia. 5. Institute for Medical Informatics, Biometry and Epidemiology, Germany. 6. Institute for Medical Informatics, Biometry and Epidemiology, Germany; Department of Epidemiology, Boston University School of Public Health, 715 Albany St, Boston, MA 02118, USA.
Abstract
OBJECTIVES: The aim of the study was to compare nationwide time trends of oral anticoagulant prescriptions with the time trend of gastrointestinal bleeding (GIB) in Germany from 2005 through 2016. PATIENTS AND METHODS: The annual number of hospital admissions for GIB associated with gastric ulcers, duodenal ulcers, hematemesis, melena, hematochezia, and unspecified gastrointestinal bleeding (USGIH) was taken from the nationwide hospital referral file by the Federal Bureau of Statistics. The hospitalization rates were age-standardized using the German Standard Population 2011. The defined daily doses (DDD) of prescribed anticoagulants in outpatients for the same calendar period were taken from reports of the drug information system of the statutory health insurance. Based on DDD, drug treatment rates were calculated per 100,000 people. RESULTS: From 2005 to 2016, the annual anticoagulant prescription rates per 100,000 persons increased by 135.8% (from 901.4 to 2125.9). By 2011, direct oral anticoagulants (DOAC) accounted for <0.1% of all anticoagulants, but 49.9% in 2016. Over the same period, age-standardized hospital admissions for GIBs per 100,000 person-years decreased by 14% (from 128.89 to 110.87). Hospitalization rates for gastric ulcer and duodenal ulcer decreased steadily, and those for hematoma, melena and hematochezia continued to increase. Only the USGIH decreased from 2005 to 2011 (annual change of -3.35 (95% CI -5.44; -1.25) per 100,000 person-years) and subsequently increased (0.61, 95% CI -0,42; 1.65). Of all GIB cases, 5.8% received at least 6 red blood cell concentrates in 2005 and 4.6% in 2016. The two-phase time trend for USGIH was no longer present in this subgroup. CONCLUSION: Our nationwide comparison of outpatient OAC treatment rates and hospitalization rates for GIBs showed that GIB hospitalization rates declined despite increasing OAC treatment rates from 2005 to 2016. With increasing impact of DOACs after 2011, this decline was not affected.
OBJECTIVES: The aim of the study was to compare nationwide time trends of oral anticoagulant prescriptions with the time trend of gastrointestinal bleeding (GIB) in Germany from 2005 through 2016. PATIENTS AND METHODS: The annual number of hospital admissions for GIB associated with gastric ulcers, duodenal ulcers, hematemesis, melena, hematochezia, and unspecifiedgastrointestinal bleeding (USGIH) was taken from the nationwide hospital referral file by the Federal Bureau of Statistics. The hospitalization rates were age-standardized using the German Standard Population 2011. The defined daily doses (DDD) of prescribed anticoagulants in outpatients for the same calendar period were taken from reports of the drug information system of the statutory health insurance. Based on DDD, drug treatment rates were calculated per 100,000 people. RESULTS: From 2005 to 2016, the annual anticoagulant prescription rates per 100,000 persons increased by 135.8% (from 901.4 to 2125.9). By 2011, direct oral anticoagulants (DOAC) accounted for <0.1% of all anticoagulants, but 49.9% in 2016. Over the same period, age-standardized hospital admissions for GIBs per 100,000 person-years decreased by 14% (from 128.89 to 110.87). Hospitalization rates for gastric ulcer and duodenal ulcer decreased steadily, and those for hematoma, melena and hematochezia continued to increase. Only the USGIH decreased from 2005 to 2011 (annual change of -3.35 (95% CI -5.44; -1.25) per 100,000 person-years) and subsequently increased (0.61, 95% CI -0,42; 1.65). Of all GIB cases, 5.8% received at least 6 red blood cell concentrates in 2005 and 4.6% in 2016. The two-phase time trend for USGIH was no longer present in this subgroup. CONCLUSION: Our nationwide comparison of outpatientOAC treatment rates and hospitalization rates for GIBs showed that GIB hospitalization rates declined despite increasing OAC treatment rates from 2005 to 2016. With increasing impact of DOACs after 2011, this decline was not affected.
Authors: Olga von Beckerath; Alexander Matthias Paulitschek; Knut Kröger; Bernd Kowall; Frans Santosa; Andreas Stang Journal: J Thromb Thrombolysis Date: 2020-05 Impact factor: 2.300
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