Bleeding complications of oral anticoagulant treatment: an inception-cohort, prospective collaborative study (ISCOAT)

Palareti, Gualtiero; Leali, Nicoletta; Coccheri, S.; Poggi, M; Manotti, Cesare; D’Angelo, Armando; Pengo, Vittorio; Erba, Nicoletta; Moia, Marco; Ciavarella, N.; Devoto, Gianluigi; Berrettini, M; Musolesi, Serena

doi:10.1016/s0140-6736(96)01109-9

Cited by 1,245 publications

(922 citation statements)

References 27 publications

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“…Bleeding is the most frequent complication of oral anticoagulation, causing considerable morbidity and mortality [4]. Emergency reversal of anticoagulation is most commonly needed to control bleeding as quickly as possible.…”

Section: Introductionmentioning

confidence: 99%

Clinical review: Prothrombin complex concentrates - evaluation of safety and thrombogenicity

et al. 2011

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Prothrombin complex concentrates (PCCs) are used mainly for emergency reversal of vitamin K antagonist therapy. Historically, the major drawback with PCCs has been the risk of thrombotic complications. The aims of the present review are to examine thrombotic complications reported with PCCs, and to compare the safety of PCCs with human fresh frozen plasma. The risk of thrombotic complications may be increased by underlying disease, high or frequent PCC dosing, and poorly balanced PCC constituents. The causes of PCC thrombogenicity remain uncertain but accumulating evidence indicates the importance of factor II (prothrombin). With the inclusion of coagulation inhibitors and other manufacturing improvements, today's PCCs may be considered safer than earlier products. PCCs may be considered preferable to fresh frozen plasma for emergency anticoagulant reversal, and this is reflected in the latest British and American guidelines. Care should be taken to avoid excessive substitution with prothrombin, however, and accurate monitoring of patients' coagulation status may allow thrombotic risk to be reduced. The risk of a thrombotic complication due to treatment with PCCs should be weighed against the need for rapid and effective correction of coagulopathy.

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Section: Introductionmentioning

confidence: 99%

Clinical review: Prothrombin complex concentrates - evaluation of safety and thrombogenicity

et al. 2011

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“…5 K Hypertension is associated with an increased risk of intracranial haemorrhage, 8 and Chinese population has a higher prevalence of haemorrhagic stroke. 9 K Consequently, there is a clinical dilemma on the use of anticoagulation therapy in Chinese non-valvular AF patients with concomitant hypertension.…”

Section: Conflict Of Interestmentioning

confidence: 99%

“…7 On the other hand, hypertension is associated with an increased risk of intracranial haemorrhage. 8 There is even greater concern about this bleeding risk with anticoagulation among the Chinese population given the higher prevalence of haemorrhagic stroke in such subjects. 9 Indeed, the recommended lowest effective intensity of anticoagulation for non-valvular AF in Caucasians may not be applicable to Far Eastern patients.…”

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of oral anticoagulation therapy in Chinese patients with concomitant atrial fibrillation and hypertension

Siu

Yue

et al. 2010

J Hum Hypertens

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Limited evidence is available on the safety and efficacy of anticoagulants in non-valvular atrial fibrillation (AF) patients with concomitant hypertension. We investigated the safety and efficacy of 476 consecutive anticoagulated Chinese outpatients with non-valvular AF and hypertension. Occurrence of ischaemic stroke and major bleeding, and international normalized ratio (INR) values during these events were recorded. There was no significant difference in anticoagulation control between patients with or without hypertension. INRspecific incidence rates of the events were calculated, which showed no excessive risk for ischaemic stroke (2.5 vs 1.6% per year, P ¼ 0.22) or major bleeding (3.9 vs 3.2% per year, P ¼ 0.29) in non-valvular AF patients with or without hypertension. In multivariate analysis, congestive heart failure, smoking and high CHADS2 score were independent predictors for ischaemic stroke, whereas use of antiplatelet agents was an independent predictor for bleeding. It can be noted that hypertension was not associated with ischaemic stroke or major bleeding. Hypertensive patients who achieved target blood pressure control (o130/80 mm Hg) had a lower ischaemic stroke (0.9 vs 3.1% per year, P ¼ 0.01), but similar bleeding risk compared with those not achieving target blood pressure. Our findings demonstrate the effects of hypertension on the outcomes of warfarin therapy; further investigation is needed to clarify whether more aggressive antihypertensive therapy could result in better outcomes in hypertensive patients with non-valvular AF.

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“…33,34,37 Occult pathologic lesions (e.g., bladder tumors, GI ulcerations) may be unmasked by anticoagulation therapy. 33,36 In particular, warfarin-related ICH may represent an unmasking of underlying cerebral vasculopathies associated with cerebral amyloid angiopathy (CAA) or leukoaraiosis. In CAA, most small arteries and arterioles show marked amyloid deposition, and vessel walls (except for endothelial cells) are often replaced totally by amyloid deposits.…”

Section: Risk Factors For Warfarin-related Major Hemorrhage and Intramentioning

confidence: 99%

The decision to anticoagulate: Assessing whether benefits outweigh the risks for patients with atrial fibrillation

Merli

Weitz

2004

Clinical Cardiology

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In a review of relevant articles from the Medline database on stroke risk in atrial fibrillation (AF) and adverse events related to anticoagulation treatment, we found that research to date shows a major potential benefit of warfarin therapy (International Normalized Ratio [INR] 2.0–3.0) for patients with AF (68% risk reduction in primary stroke prevention with warfarin vs. placebo). Despite this highly significant reduction in stroke risk, fewer than 50% of eligible patients are treated, in many cases because of fears of intracranial hemorrhage (ICH). The decision to implement anticoagulant therapy to improve outcome requires balancing the decreased risk for stroke against the increased risk for ICH. Various methods have been developed to define patient‐specific stroke risk. In contrast, risk for ICH strongly correlates with the intensity of anticoagulation, which is an unpredictable but controllable variable requiring frequent dose adjustments. Recent studies have also identified subgroups of patients with neurologic pathologies who are at increased risk for ICH. However, when the INR is properly controlled, the benefit from anticoagulation therapy for patients with AF and other risk factors for stroke exceeds the risk for ICH. Careful monitoring of anticoagulation and warfarin dose titration to maintain the INR between 2.0 and 3.0 is critical for reducing the risk for ICH, as is excluding patients with neurologic conditions that increase the likelihood of ICH. Future developments, such as the introduction of oral direct thrombin inhibitors with more predictable pharmacokinetics than warfarin, may further improve the benefit‐to‐risk ratio of anticoagulation therapy for patients with AF.

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Bleeding complications of oral anticoagulant treatment: an inception-cohort, prospective collaborative study (ISCOAT)

Cited by 1,245 publications

References 27 publications

Clinical review: Prothrombin complex concentrates - evaluation of safety and thrombogenicity

Clinical review: Prothrombin complex concentrates - evaluation of safety and thrombogenicity

Safety and efficacy of oral anticoagulation therapy in Chinese patients with concomitant atrial fibrillation and hypertension

The decision to anticoagulate: Assessing whether benefits outweigh the risks for patients with atrial fibrillation

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