Bleeding complications in venous thrombosis patients on well-managed warfarin

Sandén, Per; Renlund, Henrik; Svensson, Peter; Själander, Anders

doi:10.1007/s11239-015-1305-4

Cited by 15 publications

(13 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Despite the relatively high mean age of 65.3 years in our study, the rate of clinically relevant bleeding was comparable to that found in the dabigatran arm in RE-COVER and RE-COVER II studies at 4.3 major bleedings per 100 treatment years (15). In these studies the mean age was lower at 54.8 years with age being a known risk factor for bleeding complications (8,16), TTR were also lower at 57 % compared to 68.9 % found here which may be an explanation to the low rate of bleeding complications. However, with a difference in endpoint definitions where we lack information about fall in haemoglobin and transfusion a direct comparison to these studies is difficult.…”

Section: Discussioncontrasting

confidence: 39%

“…Both in the group with high iTTR and the group with low INR variability the patients were older (▶ Table 1), but they also had less concomitant diseases. Some of the previous conditions known to increase the risk of bleeding complications among warfarin treated patients as anaemia, cardiac failure, previous major bleeding and chronic pulmonary disease were more prevalent among those with poorer INR control (8).…”

Section: Discussionmentioning

confidence: 96%

“…In these studies however the mean TTR was relatively low, being 60 % in the phase III randomized trials with dabigatran, 61 % in the phase III randomised trials with apixaban and 57.7 % in the phase III randomised trials with rivaroxaban (5)(6)(7) and may have affected the rate of complications. Well-managed warfarin has been found to have a low rate of bleeding complications among patients with VTE (8).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Bleeding complications and mortality in warfarin-treated VTE patients, dependence of INR variability and iTTR

Sandén

Renlund

Svensson³

et al. 2017

Thromb Haemost

Self Cite

View full text Add to dashboard Cite

High quality of warfarin treatment is important to prevent recurrence of venous thromboembolism (VTE) without bleeding complications. The aim of this study was to examine the effect of individual time in therapeutic range (iTTR) and International Normalised Ratio (INR) variability on bleeding risk and mortality in a large cohort of well-managed patients with warfarin due to VTE. A cohort of 16612 patients corresponding to 19502 treatment periods with warfarin due to VTE between January 1, 2006 and December 31, 2011 was retrieved from the Swedish national quality register AuriculA and matched with the Swedish National Patient Register for bleeding complications and background characteristics and the Cause of death register for occurrence and date of death. The rate of bleeding was 1.79 (confidence interval (CI) 95 % 1.66-1.93) per 100 treatment years among all patients. Those with poor warfarin treatment quality had a higher rate of clinically relevant bleeding, both when measured as iTTR below 70 %, 2.91 (CI 95 % 2.61-3.21) or as INR variability over the mean value 0.85, 2.61 (CI 95 % 2.36-2.86). Among those with both high INR variability and low iTTR the risk of clinically relevant bleeding was clearly increased hazard ratio (HR) 3.47 (CI 95 % 2.89-4.17). A similar result was found for all-cause mortality with a HR of 3.67 (CI 95 % 3.02-4.47). Both a low iTTR and a high INR variability increase the risk of bleeding complications or mortality. When combining the two treatment quality indicators patients at particular high risk of bleeding or death can be identified.

show abstract

Section: Discussioncontrasting

confidence: 39%

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Bleeding complications and mortality in warfarin-treated VTE patients, dependence of INR variability and iTTR

Sandén

Renlund

Svensson³

et al. 2017

Thromb Haemost

Self Cite

View full text Add to dashboard Cite

show abstract

“…False positive bleeding rates is also likely when based on administrative ICDcodes without a complementary chart review [18,19]. A similar study to this using administrative ICD-10 codes for estimating bleeding rates, but with real life data on warfarin with well-regulated TTR instead of NOACs in treatment for venous thromboembolism found a lower risk of major bleeding and reported a major bleeding rate of 2.36 per 100 treatment years [8]. This might be due to a slightly older Events per 100 patients years Fig.…”

Section: Discussionmentioning

confidence: 95%

Bleeding risk in patients with venous thromboembolic events treated with new oral anticoagulants

Wallvik

Renlund

Själander

2020

J Thromb Thrombolysis

Self Cite

View full text Add to dashboard Cite

New oral anticoagulants (NOACs) is the preferred treatment in secondary prophylaxis of venous thromboembolic events (VTE). The aim of this study was to investigate possible risk factors associated with major bleeding in VTE-patients treated with NOACs. In this retrospective register-based study we screened the Swedish anticoagulation register Auricula (during 2012.01.01–2017.12.31) to find patients and used other national registers for outcomes. Primary endpoint was major bleeding defined as bleeding leading to hospital care. Multivariate Cox-regression analysis was used to reveal risk factors. 18 219 patients with NOAC due to VTE were included. 85.6% had their first VTE, mean age was 69.4 years and median follow-up time was 183 days. The most common NOAC was rivaroxaban (54.8%), followed by apixaban (42.0%), dabigatran (3.2%) and edoxaban (0.1%). The rate of major bleeding was 6.62 (95% CI 6.19–7.06) per 100 treatment years in all patients and 11.27 (CI 9.96–12.57) in patients above 80 years of age. Statistically independent risk factors associated with major bleeding were age (normalized HR 1.38, CI 1.27–1.50), earlier major bleeding (HR 1.58, Cl 1.09–2.30), COPD (HR 1.28, CI 1.04–1.60) and previous stroke (HR 1.28, Cl 1.03–1.58) or transient ischemic attack (TIA) (HR 1.33, Cl 1.01–1.76). Prior warfarin treatment was protective (HR 0.67, CI 0.58–0.78). This real world cohort shows a high bleeding rate especially among the elderly and in patients with previous major bleeding, COPD and previous stroke or TIA. This should be considered when deciding on treatment duration and NOAC dose in these patients.

show abstract

“…Given the above discussed risks, patients with unprovoked VTE should receive ‘lifelong’ anticoagulation. Nevertheless, the guidelines recommend that extending the therapy must incorporate a balance of the VTE recurrence risk with the risk of bleeding associated with anticoagulant therapy and continue therapy until bleeding risks outweigh the benefits of reducing recurrence …”

Section: Discussionmentioning

confidence: 99%

Comparative efficacy and safety of low‐intensity warfarin therapy in preventing unprovoked recurrent venous thromboembolism: A systematic review and meta‐analysis

Jiang

Shi

Zhang

et al. 2018

Clinical Respiratory J

View full text Add to dashboard Cite

Background: Although there exists potential risk of bleeding, extended 'lifelong' conventional-intensity [international normalized ratio (INR): 2.0-3.0] warfarin anticoagulation is recommended for unprovoked venous thromboembolism (VTE) patients because of risk of recurrent VTE. Whether long-term low-intensity (INR: 1.5-2.0) warfarin therapy reduced the risk of major bleeding without substantially lowered antithrombotic efficacy is not well understood. The aim of this study was to perform a systematic review and meta-analysis to evaluate the risk-benefits of low-intensity warfarin therapy.

show abstract

Bleeding complications in venous thrombosis patients on well-managed warfarin

Cited by 15 publications

References 26 publications

Bleeding complications and mortality in warfarin-treated VTE patients, dependence of INR variability and iTTR

Bleeding complications and mortality in warfarin-treated VTE patients, dependence of INR variability and iTTR

Bleeding risk in patients with venous thromboembolic events treated with new oral anticoagulants

Comparative efficacy and safety of low‐intensity warfarin therapy in preventing unprovoked recurrent venous thromboembolism: A systematic review and meta‐analysis

Contact Info

Product

Resources

About