eCite Digital Repository

Bleeding-related admissions in patients with atrial fibrillation receiving antithrombotic therapy: results from the Tasmanian Atrial Fibrillation (TAF) study

Citation

Admassie, E and Chalmers, L and Bereznicki, LR, Bleeding-related admissions in patients with atrial fibrillation receiving antithrombotic therapy: results from the Tasmanian Atrial Fibrillation (TAF) study, European Journal of Clinical Pharmacology, 73, (12) pp. 1681-1689. ISSN 0031-6970 (2017) [Refereed Article]

Copyright Statement

Copyright Springer-Verlag GmbH Germany 2017

DOI: doi:10.1007/s00228-017-2337-9

Abstract

Purpose: Limited data are available from the Australian setting regarding bleeding in patients with atrial fibrillation (AF) receiving antithrombotic therapy. We aimed to investigate the incidence of hospital admissions due to bleeding and factors associated with bleeding in patients with AF who received antithrombotic therapy.

Methods: A retrospective cohort study was conducted involving all patients with AF admitted to the Royal Hobart Hospital, Tasmania, Australia, between January 2011 and July 2015. Bleeding rates were calculated per 100 patientyears (PY) of follow-up, and multivariable modelling was used to identify predictors of bleeding.

Results: Of 2202 patients receiving antithrombotic therapy, 113 presented to the hospital with a major or minor bleeding event. These patients were older, had higher stroke and bleeding risk scores and were more often treated with warfarin and multiple antithrombotic therapies than patients who did not experience bleeding. The combined incidence of major and minor bleeding was significantly higher in warfarin- versus direct-acting oral anticoagulants (DOAC)- and antiplatelettreated patients (4.1 vs 3.0 vs 1.2 per 100 PY, respectively; p = 0.002). Similarly, the rate of major bleeding was higher in patients who received warfarin than in the DOAC and antiplatelet cohorts (2.4 vs 0.4 vs 0.6 per 100 PY, respectively; p = 0.001). In multivariate analysis, increasing age, prior bleeding, warfarin and multiple antithrombotic therapies were independently associated with bleeding.

Conclusion: The overall rate of bleeding in this cohort was low relative to similar observational studies. The rate of major bleeding was higher in patients prescribed warfarin compared to DOACs, with a similar rate of major bleeding for DOACs and antiplatelet agents. Our findings suggest potential to strategies to reduce bleeding include using DOACs in preference to warfarin, and avoiding multiple antithrombotic therapies in patients with AF.

Item Details

Item Type:Refereed Article
Keywords:AF, bleeding, elderly
Research Division:Medical and Health Sciences
Research Group:Pharmacology and Pharmaceutical Sciences
Research Field:Clinical Pharmacy and Pharmacy Practice
Objective Division:Health
Objective Group:Other Health
Objective Field:Health not elsewhere classified
Author:Admassie, E (Mr Endalkachew Alamneh)
Author:Chalmers, L (Dr Leanne Chalmers)
Author:Bereznicki, LR (Associate Professor Luke Bereznicki)
ID Code:121341
Year Published:2017
Deposited By:Pharmacy
Deposited On:2017-09-25
Last Modified:2017-11-23
Downloads:6 View Download Statistics

Repository Staff Only: item control page