Risk of major hemorrhage for outpatients treated with warfarin

McMahan, Deborah; Smith, David M.; Carey, Mark; Zhou, Xiao Hua

doi:10.1046/j.1525-1497.1998.00096.x

Cited by 141 publications

(108 citation statements)

References 26 publications

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“…[12][13][14] Despite its recent approval (in 2008), dabigatran surpassed warfarin in terms of the number of postmarketing surveillance reports to the FDA in 2011 and 2012. 15,16 Because of these safety concerns with dabigatran use, the Institute for Safe Medication Practices Canada considers it an important priority to make the use of anticoagulants, especially dabigatran, safer.…”

Section: Discussionmentioning

confidence: 99%

Appropriateness of Dabigatran and Rivaroxaban Prescribing for Hospital Inpatients

Chowdhry¹,

Jacques

Karovitch³

et al. 2016

CJHP

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Section: Discussionmentioning

confidence: 99%

Appropriateness of Dabigatran and Rivaroxaban Prescribing for Hospital Inpatients

Chowdhry¹,

Jacques

Karovitch³

et al. 2016

CJHP

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Section: Discussionmentioning

confidence: 99%

“…Prior studies have also provided conflicting evidence as to whether older age is an independent risk factor for warfarin-associated hemorrhage. [6][7][8] As increasing numbers of elderly patients take warfarin for atrial fibrillation, 9 more-precise data are needed on hemorrhage rates in the oldest patients.…”

Section: Introductionmentioning

confidence: 99%

“…20 Prior studies have also provided conflicting data on whether older age is a risk factor for warfarin-associated hemorrhage. 3,[6][7][8]21,22 Advantages of the current study include a considerably higher number of outcome events, more person-years of observation accumulated in the oldest patients, and separate analyses between intracranial and extracranial hemorrhages.The relationship between age and hemorrhage risk was found to be somewhat attenuated after adjustment for other medical conditions, suggesting that clinical factors related to aging mediate some of the higher risk. That an independent relationship still remained after multivariable adjustment indicates that other age-related features contribute to hemorrhage risk and were not identified in this study.…”

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confidence: 99%

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Age and the Risk of Warfarin‐Associated Hemorrhage: The Anticoagulation and Risk Factors In Atrial Fibrillation Study

Fang

Hylek

et al. 2006

J American Geriatrics Society

386

409

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OBJECTIVES-To assess whether older age is independently associated with hemorrhage risk in patients with atrial fibrillation, whether or not they are taking warfarin therapy. DESIGN-Cohort study.SETTING-Integrated healthcare delivery system. PARTICIPANTS-Thirteen thousand five hundred fifty-nine adults with nonvalvular atrial fibrillation.MEASUREMENTS-Patient data were collected from automated clinical and administrative databases using previously validated search algorithms. Medical charts were reviewed from patients hospitalized were for major hemorrhage (intracranial, fatal, requiring ≥2 units of transfused blood, or involving a critical anatomic site). Age was categorized into four categories (<60, 60-69, 70-79, and ≥80), and multivariable Poisson regression was used to assess whether major hemorrhage rates increased with age, stratified by warfarin use and adjusted for other clinical risk factors for hemorrhage.RESULTS-A total of 170 major hemorrhages were identified during 15,300 person-years of warfarin therapy and 162 major hemorrhages during 15,530 person-years off warfarin therapy. Hemorrhage rates rose with older age, with an average increase in hemorrhage rate of 1.2 (95% confidence interval (CI) 1.0-1.4) per older age category in patients taking warfarin and 1.5 (95% CI=1.3-1.8) in those not taking warfarin. Intracranial hemorrhage rates were significantly higher in those aged 80 and older (adjusted rate ratio=1.8, 95% CI=1.1-3.1 for those taking warfarin, adjusted rate ratio=4.7, 95% CI=2.4-9.2 for those not taking warfarin) than in those younger than 80. Author Contributions: Margaret Fang, Alan Go, Elaine Hylek, and Daniel Singer contributed to study concept and design, data analysis and interpretation, and preparation of manuscript. Yuchiao Chang contributed to data analysis and interpretation, and preparation of manuscript. Lori Henault and Nancy Jensvold contributed to study concept and design and acquisition of subjects and data. Anticoagulation therapy with warfarin effectively reduces the risk of ischemic stroke associated with atrial fibrillation but also increases the risk for major hemorrhage. [1][2][3][4] Although previous randomized trials of warfarin for atrial fibrillation reported low rates of hemorrhage, these studies included few patients aged 80 and older and selected their patients more rigorously than in actual clinical practice. 1,5 It is uncertain whether the low bleeding rates observed in trial settings apply to patients with atrial fibrillation in usual clinical care. Prior studies have also provided conflicting evidence as to whether older age is an independent risk factor for warfarin-associated hemorrhage. 6-8 As increasing numbers of elderly patients take warfarin for atrial fibrillation, 9 more-precise data are needed on hemorrhage rates in the oldest patients. NIH Public AccessMost observational studies of warfarin did not specifically address the risk of hemorrhage in patients with atrial fibrillation. Studies generally included patients taking warfarin for m...

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“…Of course, decisions about the use of warfarin need to be individualized for patients at higher risk of bleeding, such as those with alcoholism, renal insufficiency, or a previous gastrointestinal bleed. 40 The evidence regarding treatment of patients with lone AF is scant, as no trials specifically addressed this population. However, a review of patients with lone AF 32 who were enrolled in BAATAF, 17 SPAF I, 15 and SPINAF 18 found low stroke rates for these patients in the placebo arms.…”

Section: Discussionmentioning

confidence: 99%

Prevention of thromboembolism in atrial fibrillation

et al. 2000

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OBJECTIVE: Appropriate use of drugs to prevent thromboembolism in patients with atrial fibrillation (AF) involves comparing the patient's risk of stroke and risk of hemorrhage. This review summarizes the evidence regarding the efficacy of these medications. METHODS:We conducted a meta-analysis of randomized controlled trials of drugs used to prevent thromboembolism in adults with nonpostoperative AF. Articles were identified through the Cochrane Collaboration's CENTRAL database and MEDLINE until May 1998. A trial fibrillation (AF) is an increasingly common cardiac dysrhythmia affecting over 2 million people in the United States. 1-3 Restoration of sinus rhythm may involve consultation with a cardiologist; however, the prevention of cardioembolic events in patients who remain in AF falls within the domain of the primary care physician. 4 With a recently estimated 3.9 million office visits yearly for patients with AF, 5 internists need to aware of the current evidence regarding prevention of thromboembolic disease in order to provide the best care for their patients. MAIN RESULTS:The estimate that only one third of patients in AF are receiving warfarin is remarkably consistent across studies, 4,6-8 and has raised concerns that warfarin is greatly underutilized in patients with chronic AF. However, for interventions like warfarin that involve significant trade-offs, clinicians need a reliable synthesis of information on risks and benefits in order to make appropriate recommendations to patients. Therefore, we reviewed all of the randomized controlled trials involving anticoagulants and antiplatelet agents in the prevention of thromboembolism in patients with AF. Our aim was to evaluate the strength of the evidence on the efficacy and safety of the drugs used for the prevention of thromboembolic complications in adults with nonpostoperative AF and to report this information in a format useful to clinicians.

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Risk of major hemorrhage for outpatients treated with warfarin

Cited by 141 publications

References 26 publications

Appropriateness of Dabigatran and Rivaroxaban Prescribing for Hospital Inpatients

Appropriateness of Dabigatran and Rivaroxaban Prescribing for Hospital Inpatients

Age and the Risk of Warfarin‐Associated Hemorrhage: The Anticoagulation and Risk Factors In Atrial Fibrillation Study

Prevention of thromboembolism in atrial fibrillation

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