Characterisation of non-warfarin-associated bleeding events reported to the Norwegian spontaneous reporting system

Narum, Sigrid; Solhaug, Vigdis; Myhr, Kirsten; Brørs, Odd; Kringen, Marianne Kristiansen

doi:10.1007/s00228-013-1479-7

Cited by 5 publications

(10 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Mortality is around 30–50% [7,60–62] and severe physical and psychological disablement are possible in those who survive. [17] It would therefore seem to be reasonable to include all cerebral bleeds, fatal and non-fatal, in an evaluation of the risk-benefit balance of aspirin prophylaxis.…”

Section: Discussionmentioning

confidence: 99%

Systematic Review and Meta-Analysis of Randomised Trials to Ascertain Fatal Gastrointestinal Bleeding Events Attributable to Preventive Low-Dose Aspirin: No Evidence of Increased Risk

et al. 2016

View full text Add to dashboard Cite

BackgroundAspirin has been shown to lower the incidence and the mortality of vascular disease and cancer but its wider adoption appears to be seriously impeded by concerns about gastrointestinal (GI) bleeding. Unlike heart attacks, stroke and cancer, GI bleeding is an acute event, usually followed by complete recovery. We propose therefore that a more appropriate evaluation of the risk-benefit balance would be based on fatal adverse events, rather than on the incidence of bleeding. We therefore present a literature search and meta-analysis to ascertain fatal events attributable to low-dose aspirin.MethodsIn a systematic literature review we identified reports of randomised controlled trials of aspirin in which both total GI bleeding events and bleeds that led to death had been reported. Principal investigators of studies in which fatal events had not been adequately described were contacted via email and asked for further details. A meta-analyses was then performed to estimate the risk of fatal gastrointestinal bleeding attributable to low-dose aspirin.ResultsEleven randomised trials were identified in the literature search. In these the relative risk (RR) of ‘major’ incident GI bleeding in subjects who had been randomised to low-dose aspirin was 1.55 (95% CI 1.33, 1.83), and the risk of a bleed attributable to aspirin being fatal was 0.45 (95% CI 0.25, 0.80). In all the subjects randomised to aspirin, compared with those randomised not to receive aspirin, there was no significant increase in the risk of a fatal bleed (RR 0.77; 95% CI 0.41, 1.43).ConclusionsThe majority of the adverse events caused by aspirin are GI bleeds, and there appears to be no valid evidence that the overall frequency of fatal GI bleeds is increased by aspirin. The substantive risk for prophylactic aspirin is therefore cerebral haemorrhage which can be fatal or severely disabling, with an estimated risk of one death and one disabling stroke for every 1,000 people taking aspirin for ten years. These adverse effects of aspirin should be weighed against the reductions in vascular disease and cancer.

show abstract

Section: Discussionmentioning

confidence: 99%

Systematic Review and Meta-Analysis of Randomised Trials to Ascertain Fatal Gastrointestinal Bleeding Events Attributable to Preventive Low-Dose Aspirin: No Evidence of Increased Risk

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Cessation of cigarette smoking after an ischemic stroke is associated with decreased 5-year risk of stroke, myocardial infarction or death [18]. According to Gerner et al [13] and Narum et al [17], the use of NOAC and NSAID is associated with increased risk of intracerebral hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

“…The increased risk of CVD related to NSAIDs (nonsteroidal anti-inflammatory drugs) [17] and to smoking [18] was estimated using ICF categories e1101, drugs and e1109, products or substances for personal consumption, respectively. The following criteria were used: qualifier 0-NO; qualifier 4-YES.…”

Section: Icf Profilementioning

confidence: 99%

“…Close monitoring of the modifiable risk factors for CVD is crucial for the prevention of recurrent CVD events in the primary health care and ambulatory specialist care settings [4]. The widely recognized modifiable risk factors in secondary prevention of CVD include comorbid conditions (arterial hypertension, atrial fibrillation/flutter, carotid artery disease, depression, insomnia, diabetes mellitus, dyslipidemia, abnormal value of BMI (Body Mass Index)), renal and liver impairment, medication use and certain lifestyle characteristics (smoking, alcohol abuse) [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. It is worthy of note that coincidence of these risk factors is associated with increased rates of recurrent cardiovascular events [21].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The ICF Classification System to Assess Risk Factors for CVD in Secondary Prevention after Ischemic Stroke and Intracerebral Hemorrhage

et al. 2021

View full text Add to dashboard Cite

Background and objectives: Patients with a history of prior stroke have a high risk for subsequent cardiovascular events (CVD). Therefore, the implementation of an effective strategy to reduce risk factors and thereby improve secondary prevention outcomes is crucial in this patient population. The aim of this study was to determine differences in the incidence of risk factors for recurrent CVD events based on clinical type of prior stroke and to characterize them using the ICF (International Classification of Functioning, Disability and Health) classification system. Materials and Methods: The incidence of risk factors for recurrent CVD events were retrospectively analyzed in 109 patients with a history of ischemic stroke (IS) and 80 patients with a history of intracerebral hemorrhage (ICH) within 14 days poststroke. Results: Atrial fibrillation/flutter (p = 0.031), >70% carotid artery stenosis (p = 0.004), blood pressure >140/90 mmHg (p = 0.025), blood HbA1c levels >7% (p = 0.002), smoking (p = 0.026) and NSAID (nonsteroidal anti-inflammatory drug) use (p < 0.001) were significantly more common in patients with a history of ischemic stroke. However, liver function test abnormalities were observed more commonly in patients with a history of hemorrhagic stroke (p = 0.025). Conclusions: The incidence and type of risk factors for recurrent CVD events vary according to the clinical type of prior stroke. The ICF classification system is a useful tool for evaluating these risk factors. This may help reduce the risk of subsequent CVD events.

show abstract

“…Based on analyses carried out by experts of the World Health Organization (WHO), it can be concluded that about 80% of recurrent CVD incidents could be avoided if the most relevant risk factors were eliminated [ 5 ]. The generally recognised modifiable risk factors for CVD related to secondary prevention include arterial hypertension, atrial fibrillation, diabetes, dyslipidaemia, abnormal body mass index (BMI), carotid artery disease, depression, insomnia, smoking, and alcohol abuse [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. The coexistence of the above risk factors increases the likelihood of a recurrent CVD incident [ 21 ]; therefore, it is reasonable to monitor patients for all these risk factors simultaneously.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for the Recurrence of CVD Incidents in Post-Stroke Patients over a 5-Year Follow-Up Period Based on the ICF Classification

Lucki¹,

Chlebuś

Wareńczak

et al. 2021

IJERPH

View full text Add to dashboard Cite

Background and Objectives: Stroke is a strong risk factor for recurrent cardiovascular disease (CVD) incidents. The risk of post-stroke CVD incidents can be reduced by eliminating the most relevant risk factors. The aim of the study was to compare the incidence of recurrent CVD events and to determine the quantitative and qualitative differences in CVD risk factors over the 5-year follow-up period in patients with ischemic stroke (IS) and haemorrhagic stroke (ICH) with the use of ICF classification categories to present these differences. Materials and Methods: The study was retrospective. The study groups included 55 post-IS patients and 47 post-ICH patients. The results were translated into the categories from the International Classification of Functioning, Disability and Health (ICF) classification. Results: As compared to post-ICH patients, post-IS patients were significantly more frequently observed to have recurrent CVD incidents (p < 0.001), including fatal CVD incidents (p = 0.003). More risk factors in total were identified in both post-IS patients (p = 0.031) and post-ICH patients (p = 0.002) who had a recurrent CVD incident. Post-IS patients were more often found to have arterial blood pressure higher than 140/90 mmHg (p = 0.045). On the other hand, post-ICH patients were more frequently observed to have carotid artery stenosis in the range of 50–69% (p = 0.028) and an eGFR of <15 mL/min/1.73 m2 (p = 0.001). Conclusions: The type of primary stroke determines the type and incidence of risk factors as well as the recurrence rate of CVD incidents over a 5-year follow-up period. Patients after IS have a higher risk of recurrence of CVD events, including fatal ones in the 5-year follow-up compared to patients after ICH. In addition, post-IS patients who have a recurrent CVD event over a 5-year follow-up have more risk factors for a CVD event than ICH. The ICF classification can be useful for assessing and analysing risk factors for recurrent CVD incidents, which can help to improve the effectiveness of secondary prevention.

show abstract

Characterisation of non-warfarin-associated bleeding events reported to the Norwegian spontaneous reporting system

Cited by 5 publications

References 24 publications

Systematic Review and Meta-Analysis of Randomised Trials to Ascertain Fatal Gastrointestinal Bleeding Events Attributable to Preventive Low-Dose Aspirin: No Evidence of Increased Risk

Systematic Review and Meta-Analysis of Randomised Trials to Ascertain Fatal Gastrointestinal Bleeding Events Attributable to Preventive Low-Dose Aspirin: No Evidence of Increased Risk

The ICF Classification System to Assess Risk Factors for CVD in Secondary Prevention after Ischemic Stroke and Intracerebral Hemorrhage

Risk Factors for the Recurrence of CVD Incidents in Post-Stroke Patients over a 5-Year Follow-Up Period Based on the ICF Classification

Contact Info

Product

Resources

About