Factors associated with bleeding outcome of non-vitamin K antagonist oral anticoagulants at a tertiary hospital in Thailand

Main Article Content

Sarawuth Limprasert
Pornwalai Boonmuang
Daraporn Rungprai
Wanrada Meela
Vasinee Sawatwong
Sireethorn Chaianan
Rattapong Pongprasert

Abstract

This retrospective descriptive study aimed to evaluate the factors influencing bleeding in patients who received non-vitamin K antagonist oral anticoagulants (NOACs) at Phramongkutklao Hospital, Bangkok, Thailand, from January 2015 to February 2019. A total of 416 patients were included in the study. The median age was 73 years, and the median weight was 66.4 kg. NOACs were prescribed for stroke prevention in nonvalvular atrial fibrillation in the majority of the patients. Hypertension, dyslipidemia, and diabetes mellitus were respectively found in 76.2%, 59.9%, and 29.8% of the patients. Among the patients, 126 (30.3%) received dabigatran, 179 (43.0%) received rivaroxaban, 109 (26.2%) received apixaban, and 2 (9.4%) received edoxaban. Bleeding occurred in 39 patients (9.4%), including 22 (5.3%) in the rivaroxaban group, 12 (2.9%) in the dabigatran group, and 5 (1.2%) in the apixaban group. The most common bleeding type was minor bleeding. Age and previous bleeding history were factors that appeared to influence the increased bleeding outcome of NOACs. Therefore, healthcare providers should prescribe NOACs with care and closely monitor bleeding events in the elderly and patients with prior bleeding history.

Downloads

Download data is not yet available.

Article Details

How to Cite
Limprasert, S., Boonmuang, P., Rungprai, D., Meela, W., Sawatwong, V., Chaianan, S., & Pongprasert, R. (2021). Factors associated with bleeding outcome of non-vitamin K antagonist oral anticoagulants at a tertiary hospital in Thailand. Science, Engineering and Health Studies, 15, 21050009. https://doi.org/10.69598/sehs.15.21050009
Section
Health sciences

References

Akiyama, H., Uchino, K., and Hasegawa, Y. (2015). Characteristics of symptomatic intracranial hemorrhage in patients receiving non-vitamin K antagonist oral anticoagulant therapy. PLoS One, 10(7), e0132900.

Bracey, A., Shatila, W., and Wilson, J. (2018). Bleeding in patients receiving non-vitamin K oral anticoagulants: clinical trial evidence. Therapeutic Advances in Cardiovascular Disease, 12(12), 361-380.

Chan, Y.-H., See, L.-C., Tu, H.-T., Yeh, Y.-H., Chang, S.-H., Wu, L.-S., Lee, H. F., Wang, C. l., Kuo, C. F., and Kuo, C.-T. (2018). Efficacy and safety of apixaban, dabigatran, rivaroxaban, and warfarin in asians with nonvalvular atrial fibrillation. Journal of the American Heart Association, 7(8), e008150.

Cheung, K.-S., and Leung, W. K. (2017). Gastrointestinal bleeding in patients on novel oral anticoagulants: risk, prevention and management. World Journal of Gastroenterology, 23(11), 1954-1963.

Connolly, S. J., Ezekowitz, M. D., Yusuf, S., Eikelboom, J., Oldgren, J., Parekh, A., Pogue, J., Reilly, P. A., Themeles, E., Varrone, J., Wang, S., Alings, M., Xavier, D., Zhu, J., Diaz, R., Lewis, B. S., Darius, H., Diener, H. C., Joyner, C. D., and Wallentin, L. (2009). Dabigatran versus warfarin in patients with atrial fibrillation. New England Journal of Medicine, 361(12), 1139-1151.

Forbes, H. L., and Polasek, T. M. (2017). Potential drug-drug interactions with direct oral anticoagulants in elderly hospitalized patients. Therapeutic Advances in Drug Safety, 8(10), 319-328.

Gómez-Outes, A., Terleira-Fernández, A. I., Calvo-Rojas, G., Suárez-Gea, M. L., and Vargas-Castrillón, E. (2013). Dabigatran, rivaroxaban, or apixaban versus warfarin in patients with nonvalvular atrial fibrillation: a systematic review and meta-analysis of subgroups. Thrombosis, 640723.

Granger, C. B., Alexander, J. H., McMurray, J. J. V., Lopes, R. D., Hylek, E. M., Hanna, M., Al-Khalidi, H. R., Ansell, J., Atar, D., Avezum, A., Bahit, M. C., Diaz, R., Easton, J. D., Ezekowitz, J. A., Flaker, G., Garcia, D., Geraldes, M., Gersh, B. J., Golitsyn, S., Goto, S., Hermosillo, A. G., Hohnloser, S. H., Horowitz, J., Mohan, P., Jansky, P., Lewis, B. S., Lopez-Sendon, J. L., Pais, P., Parkhomenko, A., Verheugt, F., Zhu, J., and Wallentin, L. (2011). Apixaban versus warfarin in patients with atrial fibrillation. New England Journal of Medicine, 365(11), 981-992.

Hughes, M., and Lip, G. Y. (2007). Risk factors for anticoagulation-related bleeding complications in patients with atrial fibrillation: a systematic review. An International Journal of Medicine, 100(10), 599-607.

Ingrasciotta, Y., Crisafulli, S., Pizzimenti, V., Marciano, I., Mancuso, A., Ando, G., Corrao, S., Capranzano, P., and Trifiro, G. (2018). Pharmacokinetics of new oral anticoagulants: implications for use in routine care. Expert Opinion on Drug Metabolism & Toxicology, 14(10), 1057-1069.

Kaatz, S., Ahmad, D., Spyropoulos, A. C., and Schulman, S. (2015). Definition of clinically relevant non-major bleeding in studies of anticoagulants in atrial fibrillation and venous thromboembolic disease in non-surgical patients: communication from the SSC of the ISTH. Journal of Thrombosis and Haemostasis, 13(11), 2119-2126.

Kundu, A., Sardar, P., Chatterjee, S., Aronow, W. S., Owan, T., and Ryan, J. J. (2016). Minimizing the risk of bleeding with NOACs in the elderly. Drugs & Aging, 33(7), 491-500.

Levy, J. H., Douketis, J., and Weitz, J. I. (2018). Reversal agents for non-vitamin K antagonist oral anticoagulants. Nature Reviews Cardiology, 15(5), 273-281.

Kijrattanakul, P., and Rojnuckarin, P. (2020). Major bleeding complications from direct oral anticoagulants in Thai adult patients. ISTH Congress Abstracts, [Online URL: https://abstracts.isth.org/abstract/major-bleeding-complications-from-direct-oral-anticoagulants-in-thai-adult-patients/] accessed on August 6, 2021.

Patel, M. R., Mahaffey, K. W., Garg, J., Pan, G., Singer, D. E., Hacke, W., Breithardt, G., Halperin, J. L., Hankey, G. L., Piccini, J. P., Becker, R. C., Nessel, C. C., Paolini, J. F., Berkowitz, S. D., Fox, K. A. A., and Califf, R. M. (2011). Rivaroxaban versus warfarin in nonvalvular atrial fibrillation.New England Journal of Medicine, 365(10), 883-891.

Sardar, P., Chatterjee, S., Wu, W.-C., Lichstein, E., Ghosh, J., Aikat, S., and Mukherjee, D. (2013). New oral anticoagulants are not superior to warfarin in secondary prevention of stroke or transient ischemic attacks, but lower the risk of intracranial bleeding: insights from a meta-analysis and indirect treatment comparisons. PloS One, 8(10), e77694.

Sellers, M. B., and Newby, L. K. (2011). Atrial fibrillation, anticoagulation, fall risk, and outcomes in elderly patients. American Heart Journal, 161(2), 241-246.

Serebruany, V. L., Malinin, A. I., Eisert, R. M., and Sane, D. C. (2004). Risk of bleeding complications with antiplatelet agents: meta-analysis of 338,191 patients enrolled in 50 randomized controlled trials. American Journal of Hematology, 75(1), 40-47.

Steffel, J., Verhamme, P., Potpara, T. S., Albaladejo, P., Antz, M., Desteghe, L., Haeusler, K. G., Oldgren, J., Reinecke, H., Roldan-Schilling, V., Rowell, N., Sinnaeve, P., Collins, R., Camm, A. J., and Heidbuchel, H. (2018). The 2018 European heart rhythm association practical guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. European Heart Journal, 39(16), 1330-1393.

Tepper, P. G., Mardekian, J., Masseria, C., Phatak, H., Kamble, S., Abdulsattar, Y., and Lip, G. Y. H. (2018). Real-world comparison of bleeding risks among non-valvular atrial fibrillation patients prescribed apixaban, dabigatran, or rivaroxaban. PloS One, 13(11), e0205989.

Tomaselli, G. F., Mahaffey, K. W., Cuker, A., Dobesh, P. P., Doherty, J. U., Eikelboom, J. W., Florido, R., Hucker, W., Mehran, R., Messé, S. R., Pollack Jr, C. V., Rodriguez, F., Sarode, R., Siegal, D., and Wiggins, B. S. (2017). 2017 ACC expert consensus decision pathway on management of bleeding in patients on oral anticoagulants: a report of the American college of cardiology task force on expert consensus decision pathways. Journal of the American College of Cardiology, 70(24), 3042-3067.

Ufer, M. (2005). Comparative pharmacokinetics of vitamin K antagonists: warfarin, phenprocoumon and acenocoumarol. Clinical Pharmacokinetics, 44(12), 1227-1246.

Witt, D. M., Clark, N. P., Kaatz, S., Schnurr, T., and Ansell, J. E. (2016). Guidance for the practical management of warfarin therapy in the treatment of venous thromboembolism. Journal of Thrombosis and Thrombolysis, 41(1), 187-205.