학술논문
A three-year prospective study of the presentation and clinical outcomes of major bleeding episodes associated with oral anticoagulant use in the UK (ORANGE study).
Document Type
Academic Journal
Author
Green L; Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK laura.green@bartshealth.nhs.uk.; Barts Health NHS Trust, London, UK.; NHS Blood and Transplant, Colindale, UK.; Tan J; Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK.; Morris JK; Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK.; Alikhan R; University Hospital of Wales, Cardiff and Vale University Health Board, UK.; Curry N; Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.; Radcliffe Department of Medicine, University of Oxford, and Oxford BRC Haematology Theme, UK.; Everington T; Hampshire Hospitals NHS Foundation Trust, UK.; Salisbury NHS Foundation Trust, UK.; Maclean R; Sheffield Teaching Hospitals NHS Foundation Trust, UK.; Saja K; Barking, Havering and Redbridge University Hospitals NHS Trust, UK.; Stanworth S; Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.; Radcliffe Department of Medicine, University of Oxford, and Oxford BRC Haematology Theme, UK.; Transfusion Medicine, NHS Blood and Transplant, Oxford, UK.; Tait C; Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, UK.; MacCallum P; Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK.; Barts Health NHS Trust, London, UK.
Source
Publisher: Ferrata Storti Foundation Country of Publication: Italy NLM ID: 0417435 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1592-8721 (Electronic) Linking ISSN: 03906078 NLM ISO Abbreviation: Haematologica Subsets: MEDLINE
Subject
Language
English
Abstract
The outcomes of patients developing major bleeding while on oral anticoagulants remain largely unquantified. The objectives of this study were to: (i) describe the burden of major hemorrhage associated with all available oral anticoagulants in terms of proportion of bleeds which are intracranial hemorrhages, in-hospital mortality and duration of hospitalization following major bleeding; (ii) identify risk factors for mortality; and (iii) compare the characteristics of major hemorrhage between cases treated with warfarin and direct oral anticoagulants for the subgroups of patients with atrial fibrillation or venous thromboembolism. This was a multicenter, 3-year prospective cohort study of patients aged ≥18 years on oral anticoagulants who developed major hemorrhage leading to hospitalization. The patients were followed up for 30 days or until discharge or death, whichever occurred first. In total 2,192 patients (47% female, 81% on warfarin, median age 80 years) were reported between October 2013 and August 2016 from 32 hospitals in the UK. Bleeding sites were intracranial (44%), gastrointestinal (33%), and other (24%). The in-hospital mortality was 21% (95% CI: 19%-23%) overall, and 33% (95% CI: 30%-36%) for patients with intracranial hemorrhage. Intracranial hemorrhage, advanced age, spontaneous bleeding, liver failure and cancer were risk factors for death. Compared to warfarin-treated patients, patients treated with direct oral anticoagulants were older and had lower odds of subdural/epidural, subarachnoid and intracerebral bleeding. The mortality rate due to major bleeding was not different between patients being treated with warfarin or direct oral anticoagulants. Major bleeding while on oral anticoagulant therapy leads to considerable hospital stays and short-term mortality.
(Copyright© 2018 Ferrata Storti Foundation.)
(Copyright© 2018 Ferrata Storti Foundation.)