861 RISKS OF POST-COLONOSCOPIC POLYPECTOMY BLEEDING AND THROMBOEMBOLISM WITH WARFARIN AND DIRECT ORAL ANTICOAGULANTS: A POPULATION-BASED ANALYSIS

2021 ◽  
Vol 160 (6) ◽  
pp. S-176
Author(s):  
Louis Ho Shing Lau ◽  
Cosmos L.T. Guo ◽  
Terry Cheuk Fung Yip ◽  
Joyce W. Mak ◽  
Sunny H. Wong ◽  
...  
Keyword(s):  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Population Based ◽  
Colonoscopic Polypectomy

458Real world persistence with direct oral anticoagulants in anticoagulation naive patients with atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Denas ◽  
G Costa ◽  
E Ferroni ◽  
N Gennaro ◽  
U Fedeli ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Cox Regression ◽  
Anatomical Therapeutic Chemical ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Female Gender ◽  
Population Based ◽  
Real World Data

Abstract Introduction Anticoagulation therapy is central for the management of stroke in patients with non-valvular atrial fibrillation (NVAF). Persistence with oral anticoagulation is essential to prevent thromboembolic complications. Purpose To assess persistence levels of DOACs and look for possible predictors of treatment discontinuity in NVAF patients. Methods We performed a population-based retrospective cohort study in the Veneto Region (north-eastern Italy, about 5 million inhabitants) using the regional health system databases. Naïve patients initiating direct oral anticoagulants (DOACs) for stroke prevention in NVAF from July 2013 to September 2017 were included in the study. Patients were identified using Anatomical Therapeutic Chemical (ATC) codes, excluding other indications for anticoagulation therapy using ICD-9CM codes. Treatment persistence was defined as the time from initiation to discontinuation of the therapy. Baseline characteristics and comorbidities associated to the persistence of therapy with DOACs were explored by means of Kaplan-Meier curves and assessed through Cox regression. Results Overall, 17920 patients initiated anticoagulation with DOACs in the study period. Most patients were older than 74 years old, while gender was almost equally represented. Comorbidities included hypertension (72%), diabetes mellitus (17%), congestive heart failure (9%), previous stroke/TIA (20%), and prior myocardial infarction (2%). After one year, the persistence to anticoagulation treatment was 82.7%, while the persistence to DOAC treatment was 72.9% with about 10% of the discontinuations being due to switch to VKAs. On multivariate analysis, factors negatively affecting persistence were female gender, younger age (<65 years), renal disease and history of bleeding. Conversely, persistence was better in patients with hypertension, previous cerebral ischemic events, and previous acute myocardial infarction. Persistence to DOAC therapy Conclusion This real-world data show that within 12 months, one out of four anticoagulation-naïve patients stop DOACs, while one out of five patients stop anticoagulation. Efforts should be made to correct modifiable predictors and intensify patient education.

Risks of post-colonoscopic polypectomy bleeding and thromboembolism with warfarin and direct oral anticoagulants: a population-based analysis

Gut ◽  
2021 ◽  
pp. gutjnl-2020-323600
Author(s):  
Louis HS Lau ◽  
Cosmos LT Guo ◽  
Terry CF Yip ◽  
Joyce WY Mak ◽  
Sunny H Wong ◽  
...  
Keyword(s):  
Lower Risk ◽  
Thromboembolic Event ◽  
Primary Outcome ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Colonic Polyps ◽  
Population Based ◽  
Limited Data ◽  
Thromboembolic Risk ◽  
Clinically Significant

BackgroundThere were limited data on the risk of post-polypectomy bleeding (PPB) in patients on direct oral anticoagulants (DOAC). We aimed to evaluate the PPB and thromboembolic risks among DOAC and warfarin users in a population-based cohort.MethodsWe performed a territory-wide retrospective cohort study involving patients in Hong Kong from 2012 to 2020. Patients who received an oral anticoagulant and had undergone colonoscopy with polypectomy were identified. Propensity-score models with inverse probability of treatment weighting were developed for the warfarin-DOAC and between-DOAC comparisons. The primary outcome was clinically significant delayed PPB, defined as repeat colonoscopy requiring haemostasis within 30 days. The secondary outcomes were 30-day blood transfusion requirement and new thromboembolic event.ResultsApixaban was associated with lower PPB risk than warfarin (adjusted HR (aHR) 0.39, 95% CI 0.24 to 0.63, p<0.001). Dabigatran (aHR 2.23, 95% CI 1.04 to 4.77, adjusted p (ap)=0.035) and rivaroxaban (aHR 2.72, 95% CI 1.35 to 5.48, ap=0.002) were associated with higher PPB risk than apixaban. In subgroup analysis, apixaban was associated with lower PPB risk in patients aged ≥70 years and patients with right-sided colonic polyps.For thromboembolic events, apixaban was associated with lower risk than warfarin (aHR 0.22, 95% CI 0.11 to 0.45, p<0.001). Dabigatran (aHR 2.60, 95% CI 1.06 to 6.41, ap=0.033) and rivaroxaban (aHR 2.96, 95% CI 1.19 to 7.37, ap =0.013) were associated with higher thromboembolic risk than apixaban.ConclusionsApixaban was associated with a significantly lower risk of PPB and thromboembolism than warfarin, dabigatran and rivaroxaban, particularly in older patients with right-sided polyps.

scholarly journals The use and adherence of oral anticoagulants in Primary Healthcare in Catalunya: a real-world data cohort study

2019 ◽  
Author(s):  
Maria Giner-Soriano ◽  
Jordi Cortes ◽  
Ainhoa Gomez-Lumbreras ◽  
Oriol Prat-Vallverdú ◽  
Mª Angeles Quijada-Manuitt ◽  
...  
Keyword(s):  
Cohort Study ◽  
Stroke Prevention ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Platelet Aggregation Inhibitors ◽  
Population Based ◽  
Real World Data ◽  
Implementation Phase ◽  
Aggregation Inhibitors ◽  
Data Source

Abstract Background The use of direct oral anticoagulants (DOAC) for stroke prevention in non-valvular atrial fibrillation (NVAF) has not been previously assessed in our setting. We aimed to describe sociodemographic, comorbidities, co-medication and risk of thromboembolic events and bleeding in patients with NVAF initiating oral anticoagulants (OAC) for stroke prevention, and to estimate adherence and persistence to OAC.Methods Population-based cohort study including all NVAF adult patients initiating OAC for stroke prevention in August 2013-December 2015. Persistence was measured in patients initiating OAC in August 2013-December 2014. Data source is SIDIAP, which captures electronic health records from Primary Health Care in the Catalan Health Institute, covering approximately 5.8 million people.Results 51,690 NVAF patients initiated OAC; 47,197 (91.3%) were naive to OAC and 32,404 initiated acenocoumarol (62.7%). Mean age was 72.8 years (SD 12.3) and 49.4% were women. Platelet-aggregation inhibitors were taken by 9,105 (17.6%) of the patients. For 22,075 patients, persistence was higher among the non-naive patients [n=258 (61.7%)] than among the naive [n=11,502 (53.1%)]. Adherence was estimated for patients initiating DOAC and was similar in naive and non-naive patients. Among the naive to DOAC treatment, those starting rivaroxaban showed a highest proportion [(n=360 (80.1%)] of good adherence at implementation (MPR>80%) while patients starting dabigatran were less adherent [n= 203 47.8%)].Conclusions Acenocoumarol was the most frequently prescribed OAC as first therapy in NVAF patients. Non-naive to DOAC showed better persistence than naive. Rivaroxaban showed higher proportion of adherent patients during the implementation phase than apixaban and dabigatran the lowest.

scholarly journals Risk of major bleeding among users of direct oral anticoagulants combined with interacting drugs: A population‐based nested case–control study

2020 ◽  
Vol 86 (6) ◽  
pp. 1150-1164 ◽  
Author(s):  
Yumao Zhang ◽  
Patrick C. Souverein ◽  
Helga Gardarsdottir ◽  
Hendrika A. Ham ◽  
Anke‐Hilse Maitland‐van der Zee ◽  
...  
Keyword(s):  
Major Bleeding ◽  
Case Control Study ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Population Based ◽  
Case Control ◽  
Nested Case Control ◽  
Control Study

scholarly journals Comparative Effectiveness and Safety of Low-Dose Oral Anticoagulants in Patients With Atrial Fibrillation

2022 ◽  
Vol 12 ◽  
Author(s):  
Sylvie Perreault ◽  
Alice Dragomir ◽  
Robert Côté ◽  
Aurélie Lenglet ◽  
Simon de Denus ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Comparative Effectiveness ◽  
Lower Risk ◽  
Low Dose ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Significant Risk ◽  
Population Based ◽  
Pharmacokinetic Data ◽  
Effectiveness Endpoint

Aims: Observational studies of various dose levels of direct oral anticoagulants (DOACs) for patients with atrial fibrillation (AF) found that a high proportion of patients received a dose lower than the target dose tested in randomized controlled trials. There is a need to compare low-dose DOACs with warfarin or other DOACs on effectiveness and safety.Methods: Using administrative data from Quebec province, Canada, we built a cohort of new warfarin or DOAC users discharged from hospital between 2011 and 2017. We determined CHA2DS2-VASc and HAS-BLED scores, and comorbidities for 3-year prior cohort entry. The primary effectiveness endpoint was a composite of ischemic stroke/systemic embolism (SE), and secondary outcomes included a safety composite of major bleeding (MB) events and effectiveness composite (stroke/SE, death) at 1-year follow-up. We contrasted each low-dose DOAC with warfarin or other DOACs as references using inverse probability of treatment weighting to estimate marginal Cox hazard ratios (HRs).Results: The cohort comprised 22,969 patients (mean age: 80–86). We did not find a significant risk reduction for the stroke/SE primary effectiveness endpoint for DOACs vs. warfarin; however, we observed a significantly lower risk for low-dose dabigatran vs. warfarin (HR [95%CI]: 0.59 [0.42–0.81]) for effectiveness composite, mainly due to a lower death rate. The differences in effectiveness and safety composites between low-dose rivaroxaban vs. warfarin were not significant. However, low-dose apixaban had a better safety composite (HR: 0.68 [0.53–0.88]) vs. warfarin. Comparisons of dabigatran vs. apixaban showed a lower risk of stroke/SE (HR: 0.53 [0.30–0.93]) and a 2-fold higher risk of MB. The MB risk was higher for rivaroxaban than for apixaban (HR: 1.58 [1.09–2.29]).Conclusions: The results of this population-based study suggest that low-dose dabigatran has a better effective composite than warfarin. Compared with apixaban, low-dose dabigatran had a better effectiveness composite but a worse safety profile. Low-dose apixaban had a better safety composite than warfarin and other low-dose DOACs. Given that the comparative effectiveness and safety seem to vary from one DOAC to another, pharmacokinetic data for specific populations are now warranted.

Abstract 15237: Predictors of Intracranial and Gastrointestinal Bleeding in Cirrhosis With Use of Direct Oral Anticoagulants: A Large Population Based Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Muhammad U Butt ◽  
Aun R Shah ◽  
Osama Hamid ◽  
Sara Ghoneim ◽  
Maham Malik
Keyword(s):  
Risk Factors ◽  
Gastrointestinal Bleeding ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Large Population ◽  
Bleeding Risk ◽  
Population Based ◽  
Snomed Ct ◽  
Risk Of Bleeding ◽  
Cirrhotic Patients

Introduction: Use of Direct Oral Anticoagulants (DOACs) in patients with cirrhosis remains controversial, as the studies demonstrating safety of DOACs excluded these patients. Hypothesis: To determine the predictors of Intracranial and Gastrointestinal bleeding in cirrhosis with use of DOACs. Methods: We reviewed data from a large commercial database (Explorys IBM) that aggregates electronic health records from 26 large nationwide healthcare systems. Using systemized nomenclature of clinical medical terms (SNOMED CT), we identified adults with liver cirrhosis, intracranial and gastrointestinal bleeding. Risk factors known to be associated with bleeding such as alcohol abuse, NSAIDs, CKD and advanced age were collected. Bleeding risk with DOAC use was compared with coumadin. Univariable and multivariable logistic regression analyses were performed to investigate strongest predictors Results: Out of 61.4 million active adult patients in the database, 468,580 patients (0.61%) had documented cirrhosis. 9.14 % and 3.14 % of the cirrhotic patients were on DOACs and coumadin, respectively. In cirrhotic patients, there was higher composite risk of ICH or GIB if they were on DOACs (35.47% vs 21.24 % OR 2.04 [2.01-2.07]), used NSAIDs (31.15% vs 23.63% OR 1.46 [1.44-1.48]), had CKD (32.61% vs 25.04 %, OR 1.45 [1.42-1.47]), or abused alcohol (36.22% vs 23.57%, OR 1.84 [1.81- 1.87]). Risk of bleeding was higher with DOACs as compared to coumadin (35.47% vs 22.81%: p< 0.001). In Multivariable model CKD modified composite bleeding risk of ICH or GIB after adjustment for other risk factors. A cirrhotic patient on DOAC had higher risk of bleeding with CKD (OR 2.29 [(2.22-2.37)]) than without CKD (OR 1.66 [(1.63-1.69)]). This interaction was found to be statistically significant. Similar trend was noticed with use of coumadin. Conclusions: Major bleeding risk in cirrhosis was significantly higher with use of DOACs as compared to warfarin. This risk was highest in patients with CKD.

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