Safety and differences between direct oral anticoagulants and vitamin K antagonists in the risk of post-traumatic intrathoracic bleeding after rib fractures in elderly patients

Closed chest traumas are frequent consequences of falls in the elderly. The presence of concomitant oral anticoagulant therapy can increase the risk of post-traumatic bleeding even in cases of trauma with non-severe dynamics. There is limited information about the differences between vitamin K antagonists and direct oral anticoagulants in the risk of post-traumatic bleeding. To assess differences in the risk of developing intra-thoracic hemorrhages after chest trauma with at least one rib fracture caused by an accidental fall in patients over 75 years of age taking oral anticoagulant therapy. This study involved data from four emergency departments over two years. All patients on oral anticoagulant therapy and over 75 years of age who reported a closed thoracic trauma with at least one rib fracture were retrospectively evaluated. Patients were divided into two study groups according their anticoagulant therapy. Of the 342 patients included in the study, 38.9% (133/342) were treated with direct oral anticoagulants and 61.1% (209/342) were treated with vitamin K antagonist. A total of 7% (24/342) of patients presented intrathoracic bleeding, while 5% (17/342) required surgery or died as a result for the trauma. Posttraumatic intrathoracic bleeding occurred in 4.5% (6/133) of patients receiving direct oral anticoagulants and 8.6% (18/209) of patients receiving vitamin K antagonist. Logistic regression analysis, revealed no difference in the risk of intrathoracic haemorrhages between the two studied groups. Direct oral anticoagulants therapy presents a risk of post-traumatic intrathoracic haemorrhage comparable to that of vitamin K antagonist therapy.

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Factors Associated With the Choice of Oral Anticoagulant Class in the Older Patients: An Observational Study

Journal of Cardiovascular Pharmacology and Therapeutics ◽

10.1177/1074248420917811 ◽

2020 ◽

Vol 25 (4) ◽

pp. 332-337

Author(s):

Arnaud Pagès ◽

Rémi Sabatier ◽

Brigitte Sallerin

Keyword(s):

Vitamin K ◽

Oral Anticoagulant ◽

Older Patients ◽

Vitamin K Antagonists ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Female Gender ◽

Vitamin K Antagonist ◽

Factors Associated ◽

Stage 4

Aim: Oral anticoagulants are the first-line drugs for treating thrombotic disorders related to nonvalvular atrial fibrillation and for treating deep vein thrombosis, diseases that increase in prevalence with age. Older patients have a greater risk of thrombotic and hemorrhagic events and are more prone to drug interactions. Given this backdrop, we wanted to determine the factors associated with the prescription of direct oral anticoagulants and vitamin K antagonists in older patients. Methods: We performed a cross-sectional observational study using a hospital prescription database. The study population consists of 405 older patients who were given oral anticoagulants. The 2 variables of interest were the prescription of 1 of the 2 classes of oral anticoagulants (direct oral anticoagulants vs vitamin K antagonists) and appropriateness of oral anticoagulant prescribing according to Summary of Product Characteristics (potentially inappropriate vs appropriate). Results: The factors associated with direct oral anticoagulant prescribing were the female gender (odds ratio [OR]: 1.87, 95% confidence interval [CI]: 1.22-2.88) and initiation during hospital stay (OR: 2.56, 95% CI: [1.52-4.32]). Stage 4 and 5 chronic kidney diseases (OR: 0.39, 95% CI: [0.19-0.79] and OR: 0.07, 95% CI: [0.01-0.53]) were factors favoring vitamin K antagonist prescription. Being 90 years of age or more (OR: 2.05, 95% CI: [1.06-3.98]) was a factor for potentially inappropriate anticoagulant prescribing. The gastroenterology department (OR: 2.91, 95% CI: [1.05-8.11]) was associated with potentially inappropriate anticoagulant prescribing. Conclusions: Direct oral anticoagulants are the drugs of choice for anticoagulant treatment, including in older adults. The female gender and the initiation during hospital stay increased the chances of being prescribed a direct oral anticoagulant in older adults. Stage 4 and 5 chronic kidney disease increased the likelihood of having a vitamin K antagonist prescribed. Our study also revealed a persistence of potentially inappropriate oral anticoagulant prescriptions in older patients.

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Analysis of Recurrent Stroke Volume Between VKA (Vitamin K Antagonist) and Three NOACs (Non-Vitamin K Antagonist Oral Anticoagulants) Under Oral Anticoagulant Therapy

International Journal of Pharmaceutical Sciences Research ◽

10.15344/2394-1502/2016/116 ◽

2016 ◽

Vol 3 (1) ◽

Cited By ~ 1

Author(s):

Hiroaki Oguro ◽

Ryo Mizuhara ◽

Satoshi Abe ◽

Hiroyuki Takayoshi ◽

Shingo Mitaki ◽

...

Keyword(s):

Stroke Volume ◽

Anticoagulant Therapy ◽

Vitamin K ◽

Oral Anticoagulant ◽

Recurrent Stroke ◽

Oral Anticoagulant Therapy ◽

Oral Anticoagulants ◽

Vitamin K Antagonist

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Non-vitamin K antagonist oral anticoagulant therapy in a patient with atrial fibrillation and concomitant prostate cancer

Kardiologia Polska ◽

10.5603/kp.2016.0082 ◽

2016 ◽

pp. 55-57

Author(s):

Grzegorz Sławiński ◽

Ewa Lewicka ◽

Grzegorz Raczak

Keyword(s):

Prostate Cancer ◽

Atrial Fibrillation ◽

Anticoagulant Therapy ◽

Vitamin K ◽

Oral Anticoagulant ◽

Oral Anticoagulant Therapy ◽

Vitamin K Antagonist

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Suspension of Vitamin K Antagonists Is Not Required for Cataract Surgery: A Prospective Study in a Cohort of 135 Consecutive Patients on Long-Term Anticoagulant Therapy.

Blood ◽

10.1182/blood.v108.11.882.882 ◽

2006 ◽

Vol 108 (11) ◽

pp. 882-882

Author(s):

Berardino Pollio ◽

Giuseppe A. Demarie ◽

Patrizia Ocello ◽

Grazia Delios ◽

Marco Tucciarone ◽

...

Keyword(s):

Cataract Surgery ◽

Anticoagulant Therapy ◽

Vitamin K ◽

Oral Anticoagulant ◽

Oral Anticoagulant Therapy ◽

Vitamin K Antagonists ◽

Management Service ◽

Corneal Incision ◽

Standardized Protocol

Abstract The perioperative management of oral anticoagulant therapy (OAT) often arouses controversy between surgeons and internists. In geriatric patients, cataract surgery for those who are taking vitamin K antagonists is a common clinical procedure. Phacoemulsification requires a 3 mm incision involving a tissue devoid of blood vessels. This study reports the experience of an Italian Anticoagulation Management Service (AMS) with 135 anticoagulated patients on long-term anticoagulant therapy who underwent phacoemulsification performed by the same ophthalmologist team from January 2001 to December 2005. The patients received either topical (30%) or peribulbar (70%) anaesthesia. Data were collected by physicians with specialized software, but the dosage of oral anticoagulant was manual. Two oral vitamin K antagonisists are available in Italy: acenocumarol and warfarin. We prepared all patients in accordance with the following standardized protocol : the scheduled dose was always omitted the day before surgery an INR measurement was provided 3–5 days before the invasive procedure; if the patient’s INR was below 3, we simply omitted the scheduled dose of the day before cataract surgery if the patient’s INR was above 3, we withheld two or more scheduled doses to allow the INR to fall to 2.5 or less 1 hour before cataract surgery, INR was measured if the patient’s INR was below 2.5, phacoemulsification was performed Results: This standardized procedural protocol allowed the surgeon to carry out phacoemulsification with INR always below 2.5. We observed only one peribulbar bleeding (0.7%) during peribulbar anaesthesia before the corneal incision was made. No thromboembolic complications were registered during three months of follow up. We compared our results with the data of an earlier cohort of 7014 conventional patients who underwent this eye surgery in the same ophthalmologic institute. We did not observe statistical differences between the two groups with regard to hemorragic complications. Conclusions: The risk of thromboembolism when antithrombotic therapy is interrupted is a well-grounded concern, particularly for patients with mechanical heart valves. Low molecular weight heparin bridging is a valid but more complicated alternative. Our study demonstrates the feasibility and safety of this simple standardized protocol which avoids OAT interruption. Therefore, we conclude that in patients receiving OAT, it is not necessary for the anticoagulant effect to wear off before cataract surgery is performed.

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