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Real-world data on characteristics and management of community patients receiving anticoagulation therapy who presented with acute bleeding to the emergency department at a regional australian hospital: A prospective observational study
Hanna, F and Hyppa, A and Prakash, A and Vithanarachchi, U and Dawar, HU and Sanga, Z and Olabode, G and Crisp, H and Khalafallah, AA, Real-world data on characteristics and management of community patients receiving anticoagulation therapy who presented with acute bleeding to the emergency department at a regional australian hospital: A prospective observational study, Mediterranean Journal of Hematology and Infectious Diseases, 13, (1) pp. 1-9. ISSN 2035-3006 (2021) [Refereed Article]
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Objective: To study patients receiving anticoagulants with or without antiplatelet therapy presenting at a regional Australian hospital with bleeding. The main aims are to explore: (1) patients' characteristics and management provided; (2) association between the type of anticoagulant and antiplatelet agent used and the requirement of reversal; (3) and the length of hospital stay (LoS) in conjunction with bleeding episode and management.
Methods: A prospective cross-sectional review of medical records of all patients who presented at a tertiary referral centre with bleeding while receiving anticoagulation therapy between January 2016 and June 2018. Data included: patients, demographics, investigations (kidney and liver function tests, coagulation profile, FBC), LoS, bleeding site, type of and reason for anticoagulation therapy, and management provided. Data analysis included descriptive statistics, χ2 association, and regression models.
Results: Among the 144 eligible patients, 75 (52.1%) were male, and the mean age was 76 years (SD=11.1). Gastrointestinal tract bleeding was the most common (n=48, 33.3%), followed by epistaxis (n=32, 22.2%). Atrial fibrillation was the commonest reason for anticoagulation therapy (n=65, 45.1%). Warfarin was commonly used (n=74, 51.4%), followed by aspirin (n=29, 20.1%), rivaroxaban (n=26, 18.1%), and apixaban (n=12, 8.3%). The majority had increased blood urea nitrogen (n=67, 46.5%), while 58 (40.3%) had an elevated serum creatinine level, and 59 (41.0%) had a mild reduction in eGFR. Thirty-five of the warfarinised patients (47.3%) had an INR above their condition's target range despite normal liver function. Severe anaemia (Hb<80g/L) was reported in 88 patients (61.1%). DOACs were associated with a reduced likelihood of receiving reversal (B= -1.7, P=<.001), and with a shorter LoS (B= -4.1, P=.046) when compared with warfarin, LMWH, and antiplatelet therapy.
Conclusion: Warfarin use was common among patients who presented with acute bleeding, and the INR in many warfarinised patients exceeded the target for their condition. DOACs were associated with a reduced likelihood of receiving reversal and a shorter LoS than warfarin, LMWH, which might support a broader application of DOACs into community practice.
|Item Type:||Refereed Article|
|Keywords:||anticoagulation, antiplatelets, bleeding, DOAC, length of hospital stay, outcome, reversal|
|Research Division:||Biomedical and Clinical Sciences|
|Research Group:||Clinical sciences|
|Research Field:||Emergency medicine|
|Objective Group:||Provision of health and support services|
|Objective Field:||Urgent and critical care, and emergency medicine|
|UTAS Author:||Hanna, F (Dr Fayez Hanna)|
|UTAS Author:||Vithanarachchi, U (Dr Usira Vithanarachchi)|
|UTAS Author:||Khalafallah, AA (Professor Alhossain Khalafallah)|
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