Incidence, risk factors, and outcomes of warfarin‐associated major bleeding in Thai population

Priksri, Watcharapong; Rattanavipanon, Wipharak; Saejear, Wiwat; Tanyasaensook, Krittika; Phrommintikul, Arintaya; Chulavatnatol, Suvatna; Nathisuwan, Surakit

doi:10.1002/pds.4781

Cited by 8 publications

(12 citation statements)

References 32 publications

(82 reference statements)

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“…Previously, the HAS‐BLED score showed good performance in predicting the risk of major bleeding among Thai NVAF patients receiving warfarin therapy 25 . That is in contrast with the finding from this study, which comprised all DOAC users.…”

Section: Discussioncontrasting

confidence: 99%

“…Previously, the HAS-BLED score showed good performance in predicting the risk of major bleeding among Thai NVAF patients receiving warfarin therapy. 25 That is in contrast with the finding from this study, which comprised all DOAC users. One potential explanation is the fact that the risk item "labile INR" may not be applicable to At the same level of anticoagulation, Asian patients tend to suffer a higher rate of bleeding events than other racial groups.…”

Section: Discussioncontrasting

confidence: 56%

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Comparison of the HAS‐BLED versus ORBIT scores in predicting major bleeding among Asians receiving direct‐acting oral anticoagulants

Wattanaruengchai

Nathisuwan

Karaketklang

et al. 2021

Brit J Clinical Pharma

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Aims This study aimed to evaluate the performance of HAS‐BLED and ORBIT scores in predicting bleeding risk among Asian patients with nonvalvular atrial fibrillation (NVAF) using direct‐acting oral anticoagulants (DOACs). Methods A retrospective chart review was conducted among adult patients receiving DOACs for ≥6 months during January 2013 to December 2017 in 10 tertiary care hospitals in Thailand. The area under the receiver operating curve (AUROC) method or C‐statistic was used to test the diagnostic accuracy for bleeding risk classification of HAS‐BLED and ORBIT scores. The predictive performances of the two scores were compared using DeLong's method. Results A total of 961 NVAF patients, 52.5% warfarin‐naïve and 47.5% warfarin‐experienced, with mean age of 74.25 ± 10.08 years, were included in the analysis. Mean HAS‐BLED and ORBIT scores of the cohort were 1.98 ± 1.10 and 2.37 ± 1.71, respectively. During the mean follow‐up time of 1.55 ± 1.13 years, 34 patients experienced major bleeding (2.28 events/100 patient‐year). For the overall cohort, both the HAS‐BLED and ORBIT scores showed similarly moderate predictive performance on bleeding with C‐statistic (95% confidence interval) of 0.65 (0.57‐0.74) and 0.64 (0.56‐0.71), respectively. There was no statistical significance between the two scores (P = .62). Analysis based on the status of previous warfarin use was consistent with the overall cohort. Based on the calibration analysis, both HAS‐BLED and ORBIT scores possessed moderate ability to identify those who experienced major bleeding from those who did not. Conclusion Both HAS‐BLED and ORBIT bleeding risk scores had moderate predictive performance in Asian NVAF patients receiving DOACs.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 56%

Comparison of the HAS‐BLED versus ORBIT scores in predicting major bleeding among Asians receiving direct‐acting oral anticoagulants

Wattanaruengchai

Nathisuwan

Karaketklang

et al. 2021

Brit J Clinical Pharma

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“…The most common reasons for switching to DOAC were labile international normalized ratio and occurrence of VTE/bleeding events while on warfarin. This is consistent with recent reports from Thailand suggesting that the quality of anticoagulation control with warfarin is still suboptimal, with time in therapeutic range of 41.8–53.3% 11,40 . Suboptimal time in therapeutic range is known to lead to the development of TTE/bleeding events.…”

Section: Discussionsupporting

confidence: 91%

Prescriber compliance to direct oral anticoagulant labels and impact on outcomes in Thailand

Wattanaruengchai

Nathisuwan

Rattanavipanon

et al. 2020

Brit J Clinical Pharma

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Aims This study aimed to evaluate the prescriber compliance to the approved labels of direct oral anticoagulants (DOACs) and impact of appropriateness of dosing on clinical outcomes. Methods A retrospective study was conducted using simple‐stratified random sampling of adult patients receiving ≥6 months of DOACs for various indications during 2013–2017 in 10 tertiary care hospitals. Patients were classified into 3 dosing groups including approved dose, underdosing and overdosing based on the Thai Food and Drug Administration‐approved labels. Cox proportional hazard models were used to evaluate the impact of different dosings on thromboembolic and bleeding events. Results From 1200 patients included in the data analysis, prescribing of DOACs was consistent with the approved indications in 1130 cases (94.2%) while 70 patients (5.8%) received DOACs despite having contraindications or with off‐label usage. Among 1026 cases of dosing evaluation cohort, 688 patients (67.1%) received approved doses. There were 227 (21.9%) and 110 (10.7%) cases of underdosing and overdosing, respectively. Multivariate analysis showed that underdosing was associated with an increased risk of thromboembolism 3.023 (95% confidence interval [CI]: 1.291–7.080; P = .011) while overdosing was associated with an increased risk of bleeding requiring hospitalization (adjusted hazard ratio, 3.045; 95% CI, 1.501–6.178; P = .002) and Bleeding Academic Research Consortium type 2 or more (adjusted hazard ratio, 2.196; 95% CI, 1.083–4.452; P = .029). Conclusion Prescribers’ compliance to approved indications were high. However, 1/3 of DOAC prescriptions were inconsistent with approved dosing. Dosing deviation was associated with an increase in adverse clinical outcomes.

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“…Incidence of major bleeding among patients in our hospital was estimated as 3.4 per 100 patient-years. Similarly, a tertiary care hospital in Thailand 8 and a Swedish academic center reported a major bleeding rate of 3.1 and 3.7 per 100 patient-years, respectively. 9 However, varying incidence of major bleeding was noted in a tertiary care academic center in Minneapolis (5.2 per 100 patient-years) 10 and in a large Tasmania referral hospital (2.4 per 100 patient-years).…”

Section: Discussionmentioning

confidence: 95%

Severity and Hospitalization Cost Related to Warfarin-Related Adverse Events in a Tertiary Malaysian Hospital

et al. 2022

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Introduction: Oral anticoagulant is essential for the treatment and prevention of thromboembolism. Warfarin is an effective oral anticoagulant in prevention and treatment of thromboembolism. However, warfarin is frequently associated with adverse event (AE) requiring hospitalization. Method: We performed a retrospective cohort study of all patients admitted to a large tertiary public hospital for warfarin-related AEs. Patients were grouped based on bleeding severity and the direct medical cost was also calculated. Results: During the 4 years study period, a total of 224 patients were admitted for warfarin-related AEs. Mean age of patients admitted was 65.1 years (standard deviation [SD] = 11.5). More than half, 59.6%, of them were on warfarin for prevention of stroke in atrial fibrillation or atrial flutter. Major bleeding occurred among 50.9% of the patients with gastrointestinal bleed, 34 (29.8%), as the common site of bleed. Patients with major bleed had longer median hospital stay of 4 days (interquartile range [IQR] = 5) compared to 3 (IQR = 3) days in non-major bleed. There were 17 (14.9%) death among the major bleeders. Mean medical cost for managing warfarin-related AEs was USD 708.08. Conclusion: The admitted patients were equally distributed in terms of bleeding severity. Medical cost incurred for managing warfarin-related AEs increased with the severity of bleeding.

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Incidence, risk factors, and outcomes of warfarin‐associated major bleeding in Thai population

Cited by 8 publications

References 32 publications

Comparison of the HAS‐BLED versus ORBIT scores in predicting major bleeding among Asians receiving direct‐acting oral anticoagulants

Comparison of the HAS‐BLED versus ORBIT scores in predicting major bleeding among Asians receiving direct‐acting oral anticoagulants

Prescriber compliance to direct oral anticoagulant labels and impact on outcomes in Thailand

Severity and Hospitalization Cost Related to Warfarin-Related Adverse Events in a Tertiary Malaysian Hospital

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