Bleeding‐related hospital admissions and 30‐day readmissions in patients with non‐valvular atrial fibrillation treated with dabigatran versus warfarin

Lau, Wallis C.Y.; Li, Xue; Wong, Ian C. K.; Man, Kenneth K C; Lip, Gregory Y.H.; Leung, Wai K.; Siu, Chung‐Wah; Chan, Esther W.

doi:10.1111/jth.13780

Cited by 18 publications

(20 citation statements)

References 59 publications

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“…Title and abstract screening excluded 12,019 records, a further 289 were excluded after full text screening. Finally, 22 studies were eligible for inclusion in the systematic review [13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34]. Only 20 studies were included in the meta-analyses as two scored <6 on the Newcastle–Ottawa scale.…”

Section: Resultsmentioning

confidence: 99%

Effectiveness and Safety of Direct Oral Anticoagulants versus Vitamin K Antagonists for People Aged 75 Years and over with Atrial Fibrillation: A Systematic Review and Meta-Analyses of Observational Studies

Mitchell

Watson

Welsh

et al. 2019

JCM

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Older people, are underrepresented in randomised controlled trials of direct oral anticoagulants (DOACs) for stroke prevention in atrial fibrillation (AF). The aim of this study was to combine data from observational studies to provide evidence for the treatment of people aged ≥75 years. Medline, Embase, Scopus and Web of Science were searched. The primary effectiveness outcome was ischaemic stroke. Safety outcomes were major bleeding, intracranial haemorrhage, gastrointestinal bleeding, myocardial infarction, and mortality. Twenty-two studies were eligible for inclusion. Two studies related specifically to people ≥75 years but were excluded from meta-analysis due to low quality; all data in the meta-analyses were from subgroups. The pooled risk estimate of ischaemic stroke was slightly lower for DOACs. There was no significant difference in major bleeding, mortality, or myocardial infarction. Risk of intracranial haemorrhage was 44% lower with DOACs, but risk of GI bleeding was 46% higher. Our results suggest that DOACs may be preferable for the majority of older patients with AF, provided they are not at significant risk of a GI bleed. However, these results are based entirely on data from subgroup analyses so should be interpreted cautiously. There is a need for adequately powered research in this patient group.

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Section: Resultsmentioning

confidence: 99%

Effectiveness and Safety of Direct Oral Anticoagulants versus Vitamin K Antagonists for People Aged 75 Years and over with Atrial Fibrillation: A Systematic Review and Meta-Analyses of Observational Studies

Mitchell

Watson

Welsh

et al. 2019

JCM

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“…While searching for modifiable risk factors for readmission, researchers have focused on specific diagnoses11 and high-risk medications such as anticoagulants 12…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, it is anticipated that patients taking oral anticoagulants will increase in number significantly. Despite their established efficacy, oral anticoagulants have also been implicated in complications including major gastroenterological and/or intracranial bleeding, with associated need for hospitalisation and readmission 12. Weeda et al compared the outcomes (including readmission) for about 8800 patients admitted to the hospital for pulmonary embolism treated with rivaroxaban and warfarin (bridged with heparin) 17.…”

Section: Introductionmentioning

confidence: 99%

Impact of oral anticoagulants on 30-day readmission: a study from a single academic centre

Bhattarai

Hudali

Robinson

et al. 2018

BMJ EBM

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Researchers are extensively searching for modifiable risk factors including high-risk medications such as anticoagulation to avoid rehospitalisation. The influence of oral anticoagulant therapy on hospital readmission is not known. We investigated the impact of warfarin and direct oral anticoagulants (DOACs) on all cause 30-day hospital readmission retrospectively in an academic centre. We study the eligible cohort of 1781 discharges over 2-year period. Data on age, gender, diagnoses, 30-day hospital readmission, discharge medications and variables in the HOSPITAL score (Haemoglobin level at discharge, Oncology at discharge, Sodium level at discharge, Procedure during hospitalisation, Index admission, number of hospital Admissions, Length of stay) and LACE index (Length of stay, Acute/emergent admission, Charlson comorbidity index score, Emergency department visits in previous 6 months), which have higher predictability for readmission were extracted and matched for analysis. Warfarin was the most common anticoagulant prescribed at discharge (273 patients) with a readmission rate of 20% (p<0.01). DOACs were used by 94 patients at discharge with a readmission rate of 4% (p=0.219). Multivariate logistic regression showed an increased risk of readmission with warfarin therapy (OR 1.36, p=0.045). Logistic regression did not show DOACs to be a risk factor for hospital readmission. Our data suggests that warfarin therapy is a risk factor for all-cause 30-day hospital readmission. DOAC therapy is not found to be associated with a higher risk of hospital readmission. Warfarin anticoagulation may be an important target for interventions to reduce hospital readmissions.

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“…It has been reported that dabigatran, which is commonly preferred by clinics because it is a safe and effective alternative to warfarin and does not require dose adjustment according to coagulation tests, may lead to severe bleeding in many tissues and organs, including intracranial bleeding (23). However, this drug represses proliferation in intervertebral disc tissue cells and disrupts the ECM structure.…”

Section: Figurementioning

confidence: 99%

Are the intervertebral disc tissue cells damaged when attempting to prevent thrombus formation with dabigatran which is amongst the new oral anticoagulants?

Kaplan¹,

Karaarslan²,

Yılmaz³

et al. 2018

Turkish Neurosurgery

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gatroban can be used in the prophylaxis or treatment of these diseases (21). Through pharmaceutical technology, these drugs, which are administered parenterally or subcutaneously, have been replaced with orally administered drugs (4).With the substitution of the hydroxyl in the fourth position of coumarin-derived molecules containing a 2-oxo-2H-1-█ INTRODUCTION V enous and arterial thrombosis are significant contributors to morbidity and mortality, and anticoagulant agents are a mainstay of venous thromboembolism treatment (11). Drugs such as heparin, low molecular weight heparins, fondaparinux, hirudin, bivalirudin, lepirudin, and ar-AIM: To investigate the effect of dabigatran, a new oral anticoagulant, on human primary cell cultures isolated from intact intervertebral disc tissue. MATERIAL and METHODS:Cell cultures were prepared from tissues obtained from six cases who had undergone surgery due to spinal trauma. Dabigatran, an active pharmacological agent, was applied to intact annulus fibrosus (AF)/nucleus pulposus (NP) primary cell cultures from the study group. After performing cell viability, toxicity, and proliferation tests on all cultures in the control and study groups, the surface morphologies of the samples were evaluated. Subsequently, chondroadherin (CHAD), cartilage oligomeric matrix protein (COMP), and matrix metalloproteinase (MMP)-13 and -19 expressions were measured via a real-time polymerase chain reaction (RT-PCR). Data were analyzed statistically. RESULTS:In the proliferation assays performed on the 20 th day of the study, cells in the dabigatran-supplemented group were reported to have lost 46.37% more viability than those in the control group. Expressions of all genes examined except MMP-13 were evaluated in the control group by time, but in contrast to the control group results, COMP and MMP-19 gene expressions decreased in the dabigatran-treated group. No CHAD or MMP-13 expression was noted in these cultures. CONCLUSION:The potential for a systemically applied drug to accumulate in tissue and negatively affect surrounding tissues and microstructures must be emphasized.

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Bleeding‐related hospital admissions and 30‐day readmissions in patients with non‐valvular atrial fibrillation treated with dabigatran versus warfarin

Cited by 18 publications

References 59 publications

Effectiveness and Safety of Direct Oral Anticoagulants versus Vitamin K Antagonists for People Aged 75 Years and over with Atrial Fibrillation: A Systematic Review and Meta-Analyses of Observational Studies

Effectiveness and Safety of Direct Oral Anticoagulants versus Vitamin K Antagonists for People Aged 75 Years and over with Atrial Fibrillation: A Systematic Review and Meta-Analyses of Observational Studies

Impact of oral anticoagulants on 30-day readmission: a study from a single academic centre

Are the intervertebral disc tissue cells damaged when attempting to prevent thrombus formation with dabigatran which is amongst the new oral anticoagulants?

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