Anemia and bleeding in patients receiving anticoagulant therapy for venous thromboembolism

Kuperman, Amir A.; López‐Reyes, Raquel; Bosco, Lopez-Saez Juan; Lorenzo, Alicia; Bascuñana, J.; Bancel, Dominique Farge; Maria, Andrea De; Lumbierres, Marina; Stemer, Galia; Bosch, Manuel Monreal; Braester, Andrei

doi:10.1007/s11239-018-1610-9

Cited by 22 publications

(14 citation statements)

References 29 publications

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“…37 In most studies, severe anaemia (hematocrit 0.30 or less) unrelated to acute bleeding has been associated with major anticoagulant-related bleeding. 38,39 However, there is a lack of this association in our study; this could be that all patients have hematocrit higher than 30%.…”

Section: Discussioncontrasting

confidence: 56%

Frequency of bleeding complications in Algerian patients treated with the vitamin K antagonist acenocoumarol and associated factors

Belkacemi

Merad

Berber

2021

Int J Basic Clin Pharmacol

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Background: The major complication of vitamin K antagonist (VKA) therapy is bleeding. This study aimed to estimate the rate of hemorrhagic accidents and identify the hemorrhagic factors in Algerian patients treated by the VKA, acenocoumarol.Methods: We performed a cross-sectional study in patients undergoing VKA therapy, followed in the cardiology department of the University Hospital of Sidi Bel Abbes.Results: One hundred patients were included. We recorded 22 cases of bleeding. Overdose and concomitant use of drugs that interfere with the acenocoumarol effect are significant risk factors of bleeding.Conclusions: Knowledge of predictive factors for VKA-related excessive anticoagulation seems to be of the utmost importance for improving patient management. There is a need for a national registry to assess the efficacy and safety of drug use in the short and long term. This pilot study is a cornerstone in the development of oral anticoagulation therapy monitoring in our region.

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Section: Discussioncontrasting

confidence: 56%

Frequency of bleeding complications in Algerian patients treated with the vitamin K antagonist acenocoumarol and associated factors

Belkacemi

Merad

Berber

2021

Int J Basic Clin Pharmacol

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“…One possibility is more frequent presence of occult cancer. Previous reports from the RIETE registry (Registro Informatizado Enfermedad Tromboembólica) have also demonstrated a higher risk for major bleeding in patients with anemia compared to those without [18]. In the GARFIELD registry, a gradient was observed for the association of anemia severity, rates of major bleeding, and all-cause mortality.…”

Section: Discussionmentioning

confidence: 89%

The influence of anemia on clinical outcomes in venous thromboembolism: Results from GARFIELD-VTE

Goto

Turpie

Farjat

et al. 2021

Thrombosis Research

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Clinical characteristics and outcomes of venous thromboembolism (VTE) patients with concomitant anemia are unclear. This study compares baseline characteristics, treatment patterns, and 24-month outcomes in patients with and without anemia within GARFIELD-VTE. Materials and methods: GARFIELD-VTE (ClinicalTrials.gov: NCT02155491) is a global, prospective, noninterventional registry of real-world treatment practices. Of the 10,679 patients enrolled in GARFIELD-VTE, 7698 were eligible for analysis. Primary outcomes were all-cause mortality, recurrent VTE, and major bleeding in VTE patients with or without concomitant anemia over 24-months after diagnosis. Event rates and 95% confidence intervals were estimated using Poisson regression. Adjusted hazard ratios were calculated using Cox proportional hazard models. Results: Distribution of VTE events in 2771 patients with anemia and 4927 without anemia was similar (deepvein thrombosis alone: 61⋅1% vs. 55⋅9%, pulmonary embolism ± deep vein thrombosis: 38⋅9% vs. 44⋅0%, respectively). Patients with anemia were older (62.6 year vs. 58.9 years) than those without. At baseline, VTE risk factors that were more common in patients with anemia included hospitalization (22⋅0% vs. 6⋅8%), surgery (19⋅2% vs. 8⋅2%), cancer (20⋅1% vs. 5⋅6%) and acute medical illness (8⋅3% vs. 4⋅2%). Patients with anemia were more likely to receive parenteral anticoagulation therapy alone than those without anemia (26⋅6% vs. 11⋅7%) and less likely to receive a direct oral anticoagulant (38⋅5% vs. 53⋅5%). During 24-months of follow-up, patients with anemia had a higher risk (adjusted hazard ratio [95% confidence interval]) of all-cause mortality (1⋅84 [1⋅56-2⋅18]), major bleeding (2⋅83 [2⋅14-3⋅75]). Among anemia patients, the risk of all-cause mortality and major bleeding remained higher in patients with severe anemia than in those with mild/moderate anemia, allcause mortality: HR 1⋅43 [95% CI: 1⋅21-1⋅77]; major bleeding: HR 2⋅08 [95% CI: 1⋅52-2⋅86]).

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“…Anemia poses a difficult challenge since cancer patients with anemia receiving anticoagulants were shown to have a higher rate of major bleeding compared to non-cancer patients [64] while aplastic anemia was shown to increase the risk of VTE [65].…”

Section: Factors Contributing To Frailty In Patients With Cancer-amentioning

confidence: 99%

Treatment and Prevention of Cancer-Associated Thrombosis in Frail Patients: Tailored Management

Scotté

Leroy

Chastenet

et al. 2019

Cancers

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Advanced age is one of the major determinants of frailty in patients with cancer-associated thrombosis. However, multiple other factors contribute to frailty in these patients. The identification of frailty in patients with cancer-associated thrombosis is critical as it influences the complexity of the anticoagulant treatment in this population at high risk of venous thromboembolism and bleeding. Factors that contribute to frailty in patients with cancer-associated thrombosis include age, type of cancer, comorbidities such as chronic kidney disease, poly-pharmacotherapy, treatment compliance, cognitive impairment, anemia, thrombocytopenia, mobility, nutritional status, Eastern Cooperative Oncology Group grade, risk of falls, and reduced life expectancy. In the absence of specific clinical studies current anticoagulant treatment guidelines for the management are not fully applicable to frail patients with cancer. The anticoagulant treatment should therefore benefit from a tailored approach based on an algorithm that takes into account the specificities of the malignant disease.

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Anemia and bleeding in patients receiving anticoagulant therapy for venous thromboembolism

Cited by 22 publications

References 29 publications

Frequency of bleeding complications in Algerian patients treated with the vitamin K antagonist acenocoumarol and associated factors

Frequency of bleeding complications in Algerian patients treated with the vitamin K antagonist acenocoumarol and associated factors

The influence of anemia on clinical outcomes in venous thromboembolism: Results from GARFIELD-VTE

Treatment and Prevention of Cancer-Associated Thrombosis in Frail Patients: Tailored Management

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