Evaluation of Bleeding Events Requiring Hospitalization in Patients With Atrial Fibrillation Receiving Dabigatran, Warfarin, or Antiplatelet Therapy

Riley, Tanya R.; Gauthier-Lewis, Mary L.; Sanchez, Chelsea K.; Riley, Treavor T.

doi:10.1177/0897190016630408

Cited by 8 publications

(6 citation statements)

References 14 publications

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“…Moreover, the selection of either an anticoagulant or an antiplatelet agent should be carefully determined in FD patients because dabigatran, similar to warfarin, confers a higher risk of life-threatening bleeding events than antiplatelet agents. [ 10 ] A recent systematic review indicates that administration of another anticoagulant, apixaban, does not confer an increased bleeding risk like dabigatrin. [ 11 ] Therefore, in FD patients who require anticoagulation, apixaban may be a preferred anticoagulant, and antiplatelet agents should be considered as an alternative.…”

Section: Discussionmentioning

confidence: 99%

Life-threatening bleeding from gastric mucosal angiokeratomas during anticoagulation

Kang

Kim²,

Kim³

et al. 2017

Medicine

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Rationale:Angiokeratomas are the earliest manifestation of Fabry disease (FD), and the extent of their appearance is related to disease severity. Angiokeratomas are mostly found on cutaneous regions.Patient concerns, diagnoses, interventions, and outcomes:Here we report an FD patient with widespread gastrointestinal angiokeratomas who developed life-threatening bleeding following anticoagulation for atrial fibrillation.Lessons:Careful observation for gastrointestinal bleeding is warranted for patients on anticoagulation with extensive cutaneous angiokeratomas. Furthermore, our experience suggests that surveillance is needed to assess the prevalence and extent of gastrointestinal angiokeratomas in patients with FD.

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Section: Discussionmentioning

confidence: 99%

Life-threatening bleeding from gastric mucosal angiokeratomas during anticoagulation

Kang

Kim²,

Kim³

et al. 2017

Medicine

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“…[4] Overall, patients taking warfarin have signi cantly more bleeding events than patients taking other anticoagulants (P<0.001). [5][6][7] Numerous algorithms that are based on patient factors and genetic variants have been established by multivariate linear regression with the aim of reducing the risk of bleeding during the initial days of warfarin administration. [8] In 2007, we [9,10] created an algorithm for daily warfarin dose requirements so that appropriate warfarin maintenance doses could be calculated easily.…”

Section: Introductionmentioning

confidence: 99%

The gut microbiome affects the responses of heart valve replacement patients to the anticoagulant warfarin

Wang¹,

Liu²,

Liu³

et al. 2020

Preprint

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Backgrounds: Numerous algorithms based on patient genetic variants have been established with the aim of reducing the risk of GI bleeding and thromboembolism during warfarin administration. However, approximately 35% of individual warfarin sensitivity remains unexplained. Gut microbiota composition related to the vitamin K generation should be taken into account. Methods : Faecal samples were collected from 200 inpatients undergoing heart valve replacement (HVR). Ultimately, faecal samples from 80 inpatients (27 low responders (LRs), 27 high responders (HRs) and 26 normal responders (NRs) were analyzed for microbiota composition through 16S rDNA sequencing. Fifteen samples (5 LRs, 5 HRs and 5 NRs) were also analyzed through metagenomic whole-genome shotgun (WGS) sequencing. We validated the results from 10 LRs, 10 HRs and 10 NRs. Results: Significant differences were observed in the diversity and composition of the gut microbiome among the three groups. The genera Bacteroides, Escherichia-Shigella and Klebsiella were enriched in the LRs, while the genus Enterococcus was enriched in the HRs. WGS sequencing indicated that the abundance of enzymes, modules and KO associated with bacterial vitamin K biosynthesis was significantly higher in LRs than in HRs or NRs. The 12 optimal microbial markers were identified through tenfold cross-validation with a random forest model. Conclusions: This study characterized gut microbiome in the different response to warfarin of HVR patients and suggested that gut microbiome might play an important role in the clinical warfarin anticoagulation therapy.

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“…However, several cases of serious hospitalized bleeds associated with dabigatran have been reported . When comparing dabigatran with warfarin, the literature provides inconsistent results, as some studies found a higher risk of hospitalized bleeding with dabigatran over warfarin , whereas some studies reported no increased risk . Indeed, dabigatran works rapidly following its initiation ; hence it may lead to more early‐onset bleeds.…”

Section: Introductionmentioning

confidence: 99%

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

Lau

Wong

et al. 2017

Journal of Thrombosis and Haemostasis

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Essentials Bleeding is a common cause of hospital admission and re-admission in oral anticoagulant users. Patients with dabigatran and warfarin were included to assess hospital admission risk. Dabigatran users had a higher risk of 30-day re-admission with bleeding versus warfarin users. Close monitoring following hospital discharge for dabigatran-related bleeding is warranted. SummaryBackground: Reducing 30-day hospital re-admission is a policy priority worldwide.

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Evaluation of Bleeding Events Requiring Hospitalization in Patients With Atrial Fibrillation Receiving Dabigatran, Warfarin, or Antiplatelet Therapy

Cited by 8 publications

References 14 publications

Life-threatening bleeding from gastric mucosal angiokeratomas during anticoagulation

Life-threatening bleeding from gastric mucosal angiokeratomas during anticoagulation

The gut microbiome affects the responses of heart valve replacement patients to the anticoagulant warfarin

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

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