Emergency Visits for Oral Anticoagulant Bleeding

Geller, Andrew I.; Shehab, Nadine; Lovegrove, Maribeth C.; Rose, Kathleen; Weidle, Nina J.; Goring, Sandra K.; Budnitz, Daniel S.

doi:10.1007/s11606-019-05391-y

Cited by 21 publications

(20 citation statements)

References 6 publications

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“…With the introduction of direct oral anticoagulants (DOACs) as preferred therapy over vitamin K antagonists (eg, warfarin), overall use of anticoagulants has increased markedly 1 . Concurrently, there has also been a rise in anticoagulant‐related adverse drug events (ADEs), including life‐threatening bleeding and thrombotic complications 2,3 . To address this growing health crisis, anticoagulation stewardship programs have been instituted in several health systems.…”

Section: Figurementioning

confidence: 99%

“… 1 Concurrently, there has also been a rise in anticoagulant‐related adverse drug events (ADEs), including life‐threatening bleeding and thrombotic complications. 2 , 3 To address this growing health crisis, anticoagulation stewardship programs have been instituted in several health systems.…”

mentioning

confidence: 99%

“…The marked rise in DOAC‐associated ADEs 2 is fueled by a multitude of issues. First, many patients who are prescribed a DOAC experience medication access issues related to high medication costs and variable insurance coverage that can potentially lead to gaps in therapy and thromboembolic events.…”

mentioning

confidence: 99%

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A call to action for anticoagulation stewardship

Burnett

Barnes

2022

Research and Practice in Thrombosis and Haemostasis

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Section: Figurementioning

confidence: 99%

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confidence: 99%

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A call to action for anticoagulation stewardship

Burnett

Barnes

2022

Research and Practice in Thrombosis and Haemostasis

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“…Although DOACs are more convenient and considered safer than warfarin overall ( Wang et al, 2020 ), bleeding still is the main safety concern of this long-term oral therapy. Over 6 years, emergency department (ED) visits for DOAC-related bleeding jumped from 2.3% to 37.9% with the two most prescribed DOACs in the US: rivaroxaban and apixaban ( Geller et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Eight pharmacokinetic genetic variants are not associated with the risk of bleeding from direct oral anticoagulants in non-valvular atrial fibrillation patients

et al. 2022

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Background: Atrial fibrillation (AF) is the leading cause of ischemic stroke and treatment has focused on reducing this risk through anticoagulation. Direct Oral Anticoagulants (DOACs) are the first-line guideline-recommended therapy since they are as effective and overall safer than warfarin in preventing AF-related stroke. Although patients bleed less from DOACs compared to warfarin, bleeding remains the primary safety concern with this therapy.Hypothesis: Genetic variants known to modify the function of metabolic enzymes or transporters involved in the pharmacokinetics (PK) of DOACs could increase the risk of bleeding.Aim: To assess the association of eight, functional PK-related single nucleotide variants (SNVs) in five genes (ABCB1, ABCG2, CYP2J2, CYP3A4, CYP3A5) with the risk of bleeding from DOACs in non-valvular AF patients.Methods: A retrospective cohort study was carried out with 2,364 self-identified white non-valvular AF patients treated with either rivaroxaban or apixaban. Genotyping was performed with Illumina Infinium CoreExome v12.1 bead arrays by the Michigan Genomics Initiative biobank. The primary endpoint was a composite of major and clinically relevant non-major bleeding. Cox proportional hazards regression with time-varying analysis assessed the association of the eight PK-related SNVs with the risk of bleeding from DOACs in unadjusted and covariate-adjusted models. The pre-specified primary analysis was the covariate-adjusted, additive genetic models. Six tests were performed in the primary analysis as three SNVs are in the same haplotype, and thus p-values below the Bonferroni-corrected level of 8.33e-3 were considered statistically significant.Results: In the primary analysis, none of the SNVs met the Bonferroni-corrected level of statistical significance (all p > 0.1). In exploratory analyses with other genetic models, the ABCB1 (rs4148732) GG genotype tended to be associated with the risk of bleeding from rivaroxaban [HR: 1.391 (95%CI: 1.019–1.900); p = 0.038] but not from apixaban (p = 0.487).Conclusion: Eight functional PK-related genetic variants were not significantly associated with bleeding from either rivaroxaban or apixaban in more than 2,000 AF self-identified white outpatients.

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“…Bleeding ratios are found in the nose (35%), soft tissue (21%), gastrointestinal system (15%), urinary system (15%), intracranial (4%), thorax (3%), intraocular (2%), retroperitoneal (1%). [9] In last 30 years, big developments are recorded in the field of family medicine in our country. The position of the family medicine, which is one step ahead from other departments with its protective and coordinating features, in order to follow the diseases with high mortality and morbidity which require coordination of many units such as thrombosis, cannot be denied.…”

Section: Introductionmentioning

confidence: 99%

Evaluation Of The Inpatients Who Apply With High INR-Level Due To Warfarine Use- A Retrospective Descriptive Study

Kati

Şencan

Başer

et al. 2020

Journal of Contemporary Medicine

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Bu çalışma ile warfarin tedavisi alan ve yüksek INR (uluslarası normalizasyon oranı) değerleri ile başvuran hastalarda mortaliteye etki eden nedenleri ve birinci basamak sağlık kuruluşlarından uygun olarak yararlanabilme durumlarını değerlendirmeyi amaçladık. Gereç ve Yöntem: Herhangi bir nedenle warfarin tedavisi alan, INR değeri 4 'ün üzerinde olan ve komplikasyon yaşayan 187 hasta çalışmamıza dahil edildi. Hastaların hastane epikrizlerinden hastane başvuru nedeni, hangi kliniğe başvurduğu, INR değerleri, komorbid hastalık varlığı, kan transfüzyonu ihtiyacı, tedavi sonrası sağlık durumu, warfarin endikasyonu, warfarin başlayan klinik retrospektif olarak değerlendirildi. Taburculuk durumu, warfarin kullanma süresi, takip sıklığı, birinci basamağa başvuru durumu, doz değişikliklerini hangi kliniğin yaptığı, eğitim durumu telefondan öğrenildi. Bulgular: En sık hastaneye başvuru sebepleri kanama (%22.4), dispne (%18.2), ve kusma/bulantı (%9.6) olarak belirlendi. Hastaların %34.2'sinin INR değeri 10'un üzerindeydi. En sık warfarin başlama endikasyonu AF idi. Mortaliteye etki eden prediktörler göğüs ağrısı (HR=3.808; p=0.012) ve hematemaz (HR=3.688; p=0.033) olarak değerlendirildi. Birinci basamağa doz değişimi için başvuran hasta oranı %12.3 idi. Hastaların takipleri en sık olarak kardiyoloji, evde sağlık hizmetleri, kardiyovasküler cerrahi ve nöroloji tarafından yapılmaktaydı (sırasıyla; %16, %6.4, %5.9 ve %4.3). Warfarin eğitimi alanların oranı ise %36.8 idi. Sonuç: Warfarin sık takip gerektiren ve komplikasyonları mortal olan bir ilaç olduğu için hasta eğitimi çok önemlidir ve hastaların en kolay ulaşabilecekleri sağlık hizmeti olan birinci basamak sağlık hizmetlerini kullanmaları yönünde teşvik edilmesi gerekmektedir.

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Emergency Visits for Oral Anticoagulant Bleeding

Cited by 21 publications

References 6 publications

A call to action for anticoagulation stewardship

A call to action for anticoagulation stewardship

Eight pharmacokinetic genetic variants are not associated with the risk of bleeding from direct oral anticoagulants in non-valvular atrial fibrillation patients

Evaluation Of The Inpatients Who Apply With High INR-Level Due To Warfarine Use- A Retrospective Descriptive Study

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