Bleeding risk assessment during oral anticoagulant therapy initiation

2012 ◽  
Vol 5 (2) ◽  
pp. 125-127
Author(s):  
Alejandro Lazo-Langner ◽  
Michael J Kovacs ◽  
Martha Louzada
Keyword(s):  
Risk Assessment ◽  
Anticoagulant Therapy ◽  
Oral Anticoagulant ◽  
Oral Anticoagulant Therapy ◽  
Bleeding Risk ◽  
Therapy Initiation

scholarly journals Perioperative management of anticoagulant therapy

2019 ◽  
Vol 4 (4) ◽  
pp. 144-151
Author(s):  
Johanna Wagner ◽  
Johan F. Lock ◽  
Carolin Kastner ◽  
Ingo Klein ◽  
Katica Krajinovic ◽  
...  
Keyword(s):  
Anticoagulant Therapy ◽  
Oral Anticoagulant ◽  
Oral Anticoagulant Therapy ◽  
Invasive Procedure ◽  
Bleeding Risk ◽  
Coumarin Derivative ◽  
Bridging Therapy ◽  
Perioperative Bleeding ◽  
Increased Risk ◽  
Risk For Bleeding

AbstractAbout 10% of patients taking a chronic, oral anticoagulant therapy require an invasive procedure that can be associated with an increased risk for peri-interventional or perioperative bleeding. Depending on the risk for thromboembolism and the risk for bleeding, the physician has to decide whether the anticoagulant therapy should be interrupted or continued. Patient characteristics such as age, renal function and drug interactions must be considered. The perioperative handling of the oral anticoagulant therapy differs according to the periprocedural bleeding risk. Patients requiring a procedure with a minor risk for bleeding do not need to pause their anticoagulant therapy. For procedures with an increased risk for perioperative bleeding, the anticoagulant therapy should be adequately paused. For patients on a coumarin derivative with a high risk for a thromboembolic event, a perioperative bridging therapy with a low molecular weight heparin is recommended. Due to an increased risk for perioperative bleeding in patients on a bridging therapy, it is not recommended in patients with a low risk for thromboembolism. For patients taking a non-vitamin K oral anticoagulant, a bridging therapy is not recommended due to the fast onset and offset of the medication.

scholarly journals Differences in Perceived and Predicted Bleeding Risk in Older Adults With Atrial Fibrillation: The SAGE‐AF Study

2021 ◽  
Author(s):  
Benita A. Bamgbade ◽  
David D. McManus ◽  
Robert Helm ◽  
Jordy Mehawej ◽  
Jerry H. Gurwitz ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Native American ◽  
Anticoagulant Therapy ◽  
Oral Anticoagulant ◽  
Risk Perceptions ◽  
Oral Anticoagulant Therapy ◽  
Bleeding Risk ◽  
Systematic Assessment ◽  
Patient Reported ◽  
History Of

Background Little research has evaluated patient bleeding risk perceptions in comparison with calculated bleeding risk among oral anticoagulant users with atrial fibrillation. Our objective was to investigate underestimation of bleeding risk and to describe the characteristics and patient‐reported outcomes associated with underestimation of bleeding risk. Methods and Results In the SAGE‐AF (Systematic Assessment of Geriatric Elements in Atrial Fibrillation) study, a prospective cohort study of patients ≥65 years with atrial fibrillation, a CHA 2 DS 2 ‐VASc risk score ≥2 and who were on oral anticoagulant therapy, we compared patients’ self‐reported bleeding risk with their predicted bleeding risk from their HAS‐BLED score. Among the 754 participants (mean age 74.8 years, 48.3% women), 68.0% underestimated their bleeding risk. Participants who were Asian or Pacific Islander, Black, Native American or Alaskan Native, Mixed Race or Hispanic (non‐White) (adjusted OR [AOR], 0.45; 95% CI, 0.24–0.82) and women (AOR, 0.62; 95% CI, 0.40–0.95) had significantly lower odds of underestimating their bleeding risk than respective comparison groups. Participants with a history of bleeding (AOR, 3.07; 95% CI, 1.73–5.44) and prior hypertension (AOR, 4.33; 95% CI, 2.43–7.72), stroke (AOR, 5.18; 95% CI, 1.87–14.40), or renal disease (AOR, 5.05; 95% CI, 2.98–8.57) had significantly higher odds of underestimating their bleeding risk. Conclusions We found that more than two‐thirds of patients with atrial fibrillation on oral anticoagulant therapy underestimated their bleeding risk and that participants with a history of bleeding and several comorbid conditions were more likely to underestimate their bleeding risk whereas non‐Whites and women were less likely to underestimate their bleeding risk. Clinicians should ensure that patients prescribed oral anticoagulant therapy have a thorough understanding of bleeding risk.

Duration of Oral Anticoagulant Therapy after Proximal Deep Vein Thrombosis: a Decision Analysis

1994 ◽  
Vol 71 (03) ◽  
pp. 286-291 ◽  
Author(s):  
François P Sarasin ◽  
Henri Bounameaux
Keyword(s):  
Deep Vein Thrombosis ◽  
Decision Analysis ◽  
Anticoagulant Therapy ◽  
Oral Anticoagulant ◽  
Oral Anticoagulant Therapy ◽  
Oral Anticoagulants ◽  
Bleeding Risk ◽  
Lower Limbs ◽  
Vein Thrombosis ◽  
Deep Vein

SummaryThe optimal duration of oral anticoagulant therapy following proximal deep vein thrombosis (DVT) in the lower limbs remains controversial. To compare the risk benefit tradeoffs for different treatment durations (6 to 24 weeks) we constructed a Markov-based decision analysis model which explicitly balances the time-dependent declining risk of recurrent thrombosis and pulmonary embolism against the risk of major hemorrhagic complications. Specifically, we determined the threshold below which the risk of recurrent DVT exceeds the risk of major hemorrhage if anticoagulant therapy is discontinued, and above which the benefits provided by oral anticoagulants are outweighed by their risk.Our model shows that for patients with a low hemorrhagic risk (0.5%/month), the benefit yielded by oral anticoagulants breaks off beyond the 4th month of therapy, while patients with moderate (1%/month) to high (2%/month) bleeding risk will no longer benefit from the therapy after 3 or 2.5 months, respectively.In conclusion, our model supports the validity of the usually recommended duration of 3 months of oral anticoagulation after proximal vein thrombosis in the lower limbs, but suggests that this duration should be modulated between 2.5 and 4 months depending upon individual bleeding risk. Since clinical trials can hardly handle the complexity of the addressed issue, such a model may prove very helpful in daily clinical practice.

scholarly journals Oral anticoagulant therapy in atrial fibrillation older patients with previous bleeding

2020 ◽  
Vol 90 (1) ◽  
Author(s):  
Mario Bo ◽  
Francesco Giannecchini ◽  
Martina Papurello ◽  
Enrico Brunetti
Keyword(s):  
Atrial Fibrillation ◽  
Anticoagulant Therapy ◽  
Antithrombotic Therapy ◽  
Oral Anticoagulant ◽  
Older Patients ◽  
Oral Anticoagulant Therapy ◽  
Unmet Need ◽  
Bleeding Event ◽  
Bleeding Risk ◽  
Risk Scores

Oral anticoagulant therapy (OAT) with direct oral anticoagulant (DOACs) is the established treatment to reduce thromboembolic risk in patients with atrial fibrillation (AF). Bleeding risk scores are useful to identify and correct factors associated with bleeding risk in AF patients on OAT. However, the clinical scenario is more complex in patients with previous bleeding event, and the decision about whether and when starting or re-starting OAT in these patients remains a contentious issue. Major bleeding is associated with a subsequent increase in both short- and long-term mortality, and even minimal bleeding may have prognostic importance because it frequently leads to disruption of antithrombotic therapy. There is an unmet need for guidance on how to manage antithrombotic therapy after bleeding has occurred. While waiting for observational and randomized data to accrue, this paper offers a perspective on managing antithrombotic therapy after bleeding in older patients with AF.

Clinical Performance of Bleeding Risk Scores for Predicting Major and Clinically Relevant Non-Major Bleeding Events in Patients Receiving Oral Anticoagulant Therapy

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 2311-2311
Author(s):  
Sarag Burgess ◽  
Natalie Crown ◽  
Martha L Louzada ◽  
George Dresser ◽  
Richard Kim ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Anticoagulant Therapy ◽  
Major Bleeding ◽  
Oral Anticoagulant ◽  
Oral Anticoagulant Therapy ◽  
Predictive Ability ◽  
Bleeding Risk ◽  
Risk Scores ◽  
Risk Category ◽  
Thrombotic Complications

Abstract Abstract 2311 Oral anticoagulant therapy (OAT) is effective in preventing thrombotic complications in atrial fibrillation (AF) and venous thrombosis but its use is associated with increased bleeding. Risk scores such as CHADS2 are used to predict thrombotic complications in patients with AF, but scores predicting bleeding are less studied. A number of bleeding risk scores (BRS) has been proposed, however they might have different predictive abilities and performance. Moreover, these scores aim to identify major bleeding (MB) but have not evaluated clinically relevant non-major bleeding (CRNMB). Recent guidelines advocate the use of scores to assess bleeding risk in patients with atrial fibrillation being considered for OAT despite studies suggesting their limited utility. The purpose of this study was to evaluate the performance of 4 validated BRS for predicting MB and CRNMB. We conducted a retrospective, cohort study of consecutive patients enrolled in an academic OAT clinic between September 2008 and February 2011. Information regarding bleeding risk factors was collected for 4 BRS: Outpatient Bleeding Risk Index (OBRI; Beyth et al., Am J Med 1998), Contemporary Bleeding Risk Model (CBRM; Shireman et al., Chest 2006), HEMORR2HAGES (Gage et al. Am Heart J 2006), and HAS-BLED (Pisters et al., Chest 2010). Main outcomes were MB (Schulman J Thromb Haemost 2005) and a composite of MB + CRNMB (defined as overt bleeding that does not meet the criteria for MB but is associated with medical intervention, unscheduled contact, cessation of treatment, or associated with other discomfort (e.g. pain, impairment of daily activities). Incidence rates (IR) were calculated for each BRS and risk category. Correlation of bleeding risk categories among different BRS was assessed using the Kendall's tau-b coefficient. Predictive ability of each tool was evaluated using the C-statistic. Groups were compared using Fisher's exact, χ2, Mann-Whitney U, or Student's T tests. Hazard ratios (HR) for each score and risk category were estimated using Cox regression. We included 321 consecutive patients with a total follow-up of 319.2 patient-years. Mean age (SD) was 69.2 (13.6) years, 57% were males and 72.6% had AF. Overall IR for MB and MB + CRNMB were 3.7, and 11.2 events/100 patient-years, respectively. IRs for MB and MB + CRNMB separated by BRS and risk category are shown in Table 1 together with % of patients within each category. Overall, agreement among the 4 BRS was low to moderate with Kendall's tau-b coefficients ranging from 0.295 (OBRI vs CBRM) to 0.537 (HEMORR2HAGES vs HAS-BLED). C-statistics (95%CI) for predicting MB were 0.606 (0.435–0.777), 0.714 (0.548–0.879), 0.735 (0.583–0.886), and 0.672 (0.523–0.820), whereas those for predicting MB + CRNMB were 0.549 (0.452–0.645), 0.591 (0.489–0.692), 0.613 (0.517–0.709), and 0.587 (0.487–0.686) for OBRI, CBRM, HEMORR2HAGES and HAS-BLED, respectively. HRs for MB and MB + CRNMB are shown in Table 2. The best predictive ability for both MB and MB + CRNMB was for CBRM and HEMORR2HAGES. In conclusion, BRS classified bleeding risks differently. Predictive ability was moderate for MB and poor for MB + CRNMB. Overall, BRS are more helpful to identify patients at high bleeding risk, but they did not adequately identify patients at intermediate risk. Further studies assessing both MB and CRNMB are needed.Table 1.IR for bleeding eventsEvents/100 person-years (% patients in category)Score/OutcomeRisk CategoryMBLowIntermediateHigh    OBRI6.98 (16.2)2.63 (69.8)6.15 (14.0)    CBRM1.76 (70.1)6.62 (29.0)79.00 (0.9)    HEMORR2HAGES1.32 (48.9)3.71 (41.1)14.68 (10.0)    HAS-BLED0 (10.3)2.60 (60.1)7.38 (29.6)MB + CRNMB    OBRI9.3411.9714.68    CBRM9.6216.1279.00    HEMORR2HAGES8.2014.0620.94    HAS-BLED9.879.0718.91Table 2.HR for bleeding eventsMBMB+CRNBBleeding Risk ScoreHR95% CIpHR95% CIpOBRI    LowRefRef0.278RefRef0.798    Intermediate0.380.09–1.510.1691.290.45–3.690.636    High0.900.18–4.460.8951.520.44–5.220.503CBRM    LowRefRef<0.001RefRef0.007    Intermediate3.671.04–13.010.0441.790.92–3.480.085    High39.016.99–217.70<0.0018.712.02–37.520.004HEMORR2HAGES    LowRefRef0.008RefRef0.110    Intermediate2.770.54–14.280.2241.800.88–3.720.110    High10.942.12–56.420.0042.541.00–6.460.050HAS-BLED    LowRefRef0.212RefRef0.118    IntermediateNENE0.9490.970.28–3.290.959    HighNENE0.9431.910.56–6.520.302 Disclosures: Lazo-Langner: Pfizer Inc.: Honoraria; Leo Pharma: Honoraria.

Sign in / Sign up

Export Citation Format

Share Document