Identification and preliminary validation of predictors of major bleeding in hospitalized patients starting anticoagulant therapy

Landefeld, C. Seth; Cook, E. Francis; Flatley, Margaret; Weisberg, Monica; Goldman, Lee

doi:10.1016/0002-9343(87)90004-0

Cited by 253 publications

(98 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In this study, the possibility of heterogeneity in timing of the collection of data in each institution precluded an accurate estimation of the total blood loss calculated by the Landefeld equation (which assumes that the net Hb decline corresponds to the addition of the number of blood transfusion to the baseline minus measured postoperative nadir Hb). 31 Yet, in accordance with our previous findings, 32 the current results show that patients with anemia had a smaller postoperative Hb drop but received significantly more frequent and also more units of blood transfusions compared with patients without anemia ( Figure 3). Also, the indication of blood transfusion was not related to an overt source of bleeding in ≈60% of patients with anemia.…”

Section: Prognostic Effects Of Preoperative Anemia and Blood Transfussupporting

confidence: 92%

Prevalence, Factors Associated With, and Prognostic Effects of Preoperative Anemia on Short- and Long-Term Mortality in Patients Undergoing Transcatheter Aortic Valve Implantation

Nuis¹,

Sinning

Rodés‐Cabau

et al. 2013

Circ: Cardiovascular Interventions

View full text Add to dashboard Cite

Background-There is scant information on the prevalence and factors associated with preoperative anemia in patients undergoing transcatheter aortic valve implantation (TAVI) and whether it is associated with mortality. We sought to determine the prevalence and factors associated with preoperative anemia in addition to the prognostic effects of the various levels of preoperative hemoglobin level on mortality in patients undergoing TAVI. Methods and Results-Ten-center observational study encompassing 1696 patients with aortic stenosis who underwent TAVI was conducted. Anemia was defined by the World Health Organization criteria (hemoglobin <12.0 g/dL in women and <13.0 g/dL in men). but showed the strongest association with 1-year mortality with a hazard ratio (95% confidence interval) of 2.78 (1.60-4.82) in patients with hemoglobin <10 g/dL. Patients with anemia received ≥1 blood transfusion 2× more often, but the indication of transfusion was unrelated to overt bleeding in 60%. Blood transfusion was associated with mortality at 30 days (odds ratio, 1.25 [95% confidence interval, 1.08-3.67]) and during follow-up (hazard ratio, 1.09 [95% confidence interval, 1.03-1.14]). Conclusions-Preoperative anemia is prevalent in >50% of patients undergoing TAVI. Various baseline factors were related to anemia, which in turn was associated with 1-year mortality. Patients with anemia received more transfusions but mostly for indications unrelated to overt bleeding, whereas transfusion was independently associated with both early and 1-year mortality. These findings indicate that optimization of baseline factors related to preoperative anemia, in addition to more strict criteria of the use of blood products, may improve outcome after TAVI. (Circ Cardiovasc Interv. 2013;6:625-634.)

show abstract

Section: Prognostic Effects Of Preoperative Anemia and Blood Transfussupporting

confidence: 92%

Prevalence, Factors Associated With, and Prognostic Effects of Preoperative Anemia on Short- and Long-Term Mortality in Patients Undergoing Transcatheter Aortic Valve Implantation

Nuis¹,

Sinning

Rodés‐Cabau

et al. 2013

Circ: Cardiovascular Interventions

View full text Add to dashboard Cite

show abstract

“…Our data confirm that the use of anticoagulant therapy carries a higher risk to bleed than to recur in the elderly and in the renally impaired, as previously reported 14, 21, 22, 23, 24, 25. During initial therapy with LMWH, fragile patients weighing ≤50 kg received slightly higher (non‐significantly) mean daily doses per body weight of LMWH compared with non‐fragile patients.…”

Section: Discussionsupporting

confidence: 89%

Clinical outcomes during anticoagulant therapy in fragile patients with venous thromboembolism

Moustafa

Giorgi‐Pierfranceschi²,

Micco

et al. 2017

Research and Practice in Thrombosis and Haemostasis

View full text Add to dashboard Cite

Essentials Recent randomized trials suggested fewer bleeding events in fragile patients with VTE receiving DOACs.The frequency, clinical characteristics and outcome of these patients have not been reported in real life.Fragile patients with VTE had a higher risk for major bleeding or death and a lower risk for recurrences than non‐fragile. BackgroundSubgroup analyses from randomized trials suggested favorable results for the direct oral anticoagulants in fragile patients with venous thromboembolism (VTE). The frequency and natural history of fragile patients with VTE have not been studied yet.ObjectivesTo compare the clinical characteristics, treatment and outcomes during the first 3 months of anticoagulation in fragile vs non‐fragile patients with VTE.MethodsRetrospective study using consecutive patients enrolled in the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry. Fragile patients were defined as those having age ≥75 years, creatinine clearance (CrCl) levels ≤50 mL/min, and/or body weight ≤50 kg.ResultsFrom January 2013 to October 2016, 15 079 patients were recruited. Of these, 6260 (42%) were fragile: 37% were aged ≥75 years, 20% had CrCl levels ≤50 mL/min, and 3.6% weighed ≤50 kg. During the first 3 months of anticoagulant therapy, fragile patients had a lower risk of VTE recurrences (0.78% vs 1.4%; adjusted odds ratio [OR]: 0.52; 95% confidence intervals [CI]: 0.37‐0.74) and a higher risk of major bleeding (2.6% vs 1.4%; adjusted OR: 1.41; 95% CI: 1.10‐1.80), gastrointestinal bleeding (0.86% vs 0.35%; adjusted OR: 1.84; 95% CI: 1.16‐2.92), haematoma (0.51% vs 0.07%; adjusted OR: 5.05; 95% CI: 2.05‐12.4), all‐cause death (9.2% vs 3.5%; adjusted OR: 2.02; 95% CI: 1.75‐2.33), or fatal PE (0.85% vs 0.35%; adjusted OR: 1.77; 95% CI: 1.10‐2.85) than the non‐fragile.ConclusionsIn real life, 42% of VTE patients were fragile. During anticoagulation, they had fewer VTE recurrences and more major bleeding events than the non‐fragile.

show abstract

“…11 Studies reveal median time span of 24-27 h for the reversal of INR to below 1.5 after a 1 mg intravenous dose of vitamin K. 12 This time period in our re-audit was 38 h. Vitamin K can also be given orally; however, the intravenous route achieves the quickest correction of anticoagulation, with significant effect on prothrombin time in 4-6 h. 12 Review of literature suggests an increased risk of intraand postoperative bleeding when surgery is performed in patients who are receiving an anticoagulant. [13][14][15] INR > 4 raises the risk of major haemorrhage. 16 With an INR > 1.5, patients undergoing surgery have an increased risk of postoperative bleeding complications.…”

Section: Discussionmentioning

confidence: 99%

An audit of the role of vitamin K in the reversal of International Normalised Ratio (INR) in patients undergoing surgery for hip fracture

Bhatia

Talawadekar

Parihar

et al. 2010

annals

View full text Add to dashboard Cite

INTRODUCTION The objective of this prospective audit was to compare two methods of anticoagulation reversal in the pre-operative period for hip fracture patients. PATIENTS AND METHODS In the first part of the audit, our current practice was analysed. Data relating to the number of days from admission to surgery and the reasons for delay to surgery were collected. Also, data concerning common reasons for which the patients were started on warfarin and the time required for INR to drop to 1.5 or below were collected. In the second part of the audit, 45 patients with INR above 1.5 were given a single dose of vitamin K (1 mg i.v.) in addition to stopping warfarin. RESULTS The mean difference in the time for INR < 1.5 in the two groups was 2 days (52 h; P < 0.05). The mean difference in wait for surgery since admission between the two groups was 4 days (91 h; P < 0.05). There was no significant difference between the two groups as regards the average number of co-morbidities in the patient groups. CONCLUSIONS A single 1 mg intravenous dose of vitamin K significantly reduces the time for the reversal of INR and the preoperative delay to surgery, in patients on long-term warfarin. We conclude that 1 mg of intravenous vitamin K on admission is a safe and effective treatment to avoid delay in the treatment in this group of patients.

show abstract

Identification and preliminary validation of predictors of major bleeding in hospitalized patients starting anticoagulant therapy

Cited by 253 publications

References 33 publications

Prevalence, Factors Associated With, and Prognostic Effects of Preoperative Anemia on Short- and Long-Term Mortality in Patients Undergoing Transcatheter Aortic Valve Implantation

Prevalence, Factors Associated With, and Prognostic Effects of Preoperative Anemia on Short- and Long-Term Mortality in Patients Undergoing Transcatheter Aortic Valve Implantation

Clinical outcomes during anticoagulant therapy in fragile patients with venous thromboembolism

An audit of the role of vitamin K in the reversal of International Normalised Ratio (INR) in patients undergoing surgery for hip fracture

Contact Info

Product

Resources

About