Incidence and cost of bleeding events requiring hospitalization in patients with atrial fibrillation treated with acenocoumarol in Greece

Kourlaba, Georgia; Stefanou, Garyfallia; Tsalamandris, Sotiris; Oikonomou, Evangelos; Papageorgiou, Giannis; Nikas, Nikos; Tousoulis, Dimitris; Maniadakis, Nikos

doi:10.1016/j.hjc.2020.06.013

Cited by 5 publications

(5 citation statements)

References 16 publications

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“…It is still widely used because of its low cost in many healthcare systems. The incidence of bleeding events associated with it has been estimated in a report series to be 5.1%, dominated by gastrointestinal and cerebral haemorrhage [ 10 ]. The international normalized ratio (INR) is recommended for monitoring and dose adjustment, and the risk of major bleeding increases with increasing INR value.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Iliopsoas Hematoma in a Patient on Acenocoumarol: Report of a Rare Case

Bote¹,

Boughaleb²,

Lakssir³

et al. 2023

Cureus

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Spontaneous hematoma of the iliopsoas is a rare pathological circumstance; in the majority of cases published in the literature, it is associated with disorders of hemostasis due to anticoagulant treatment or coagulopathies. We present a case of a 64-year-old man on acenocoumarol, an anticoagulant of the vitamin K antagonist family, for atrial fibrillation, who presented with a severe left hip and flank pain with a huge ecchymosis on the left flank and a partial inability to extend the left thigh. A CT scan confirmed the diagnosis of iliopsoas hematoma. Given the hemodynamic stability of the patient, he benefited from a conservative treatment with a favourable evolution. This case highlights the underlying conditions, diagnosis, and treatment of this uncommon complication.

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Section: Discussionmentioning

confidence: 99%

Spontaneous Iliopsoas Hematoma in a Patient on Acenocoumarol: Report of a Rare Case

Bote¹,

Boughaleb²,

Lakssir³

et al. 2023

Cureus

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“…Our population was limited (n=3) regarding low-risk stroke patients and all of them were administered OAC. In these lines, 53% of AF patients with a CHADS score 0 at the first year of NOACs, received OAC improperly [18]. Clinicians may be anticoagulating these patients simply because they have AF, regardless of their low rate of thrombotic events, although it is also possible that these patients may have been anticoagulated for conditions other than AF, such as valvular heart disease or venous thromboembolic events [17].…”

Section: Discussionmentioning

confidence: 99%

“…Anticoagulant agents increase bleeding risk [18] and although the overall risk may be lower with NOACs compared with warfarin, it is still not zero [19]. Although LAAC scientific societies' recommendations are weak (IIb) [1,2] there are an increasing number of LAAC procedures worldwide [20].…”

Section: Discussionmentioning

confidence: 99%

Anticoagulation Status and Left Atrial Appendage Occlusion Indications in Hospitalized Cardiology Patients with Atrial Fibrillation: A Hellenic Cardiorenal Morbidity Snapshot (HECMOS) Sub-Study

Tsiachris,

Papakonstantinou,

Doundoulakis

et al. 2023

Preprint

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Background and Objectives: Proper use of oral anticoagulants is crucial in the management of non-valvular atrial fibrillation (AF) patients. Left atrial appendage closure (LAAC) may be considered for stroke prevention in patients with AF and contraindications for long-term anticoagulant treatment. We aimed to assess the anticoagulation status and LAAC indications in patients with AF from HECMOS (Hellenic Cardiorenal Morbidity Snapshot) survey. Materials and Methods: HECMOS was a nationwide snapshot survey of cardiorenal morbidity in hospitalized cardiology patients. HECMOS used an electronic platform to collect demographic and clinically relevant information from all patients hospitalized on March 3, 2022, in 55 different cardiology departments. In this substudy, we included patients with known AF without mechanical prosthetic valves and moderate to severe mitral valve stenosis. Patients with prior stroke, previous major bleeding, poor adherence to anticoagulants, and end-stage renal disease were considered candidates for LAAC. Results: Two hundred fifty-six patients (mean age 76.6±11.7, 148 males) were included in our analysis. Most of them (n=159; 62%) suffered from persistent AF. Mean CHA2DS2-VASc score was 4.28±1.7, while mean HAS-BLED score was 1.47±0.9. Three out of 3 patients with a CHA2DS2-VASc 0 or 1 (female) received improperly anticoagulants. Sixteen out of 18 patients with a CHA2DS2-VASc 1 or 2 (female) received anticoagulants. Thirty-three out of 235 patients with a CHA2DS2-VASc &gt; 1 or 2 (for female) did not receive improperly anticoagulants. Among 221 under anticoagulant therapy, 191 (86.4%) received non-vitamin K antagonist oral anticoagulants (NOACs) and 30 (13.6%) received vitamin K antagonists. Relative indications for LAAC were present in 64 patients with NVAF (60 had only one risk factor and 2 had two concurrent risk factors). In detail, 36 had a prior stroke, 17 patients had a history of major bleeding, 15 patients reported poor or no adherence to the anticoagulant therapy and 5 had eGFR&lt; 15 ml/min/1.73m2. Moreover, 33 had a HAS-BLED score ≥3. No LAAC treatment was recorded. Conclusions: Anticoagulation status was nearly optimal in a high thromboembolic risk population of cardiology patients, mainly treated with NOACs. One out of four AF patients should be screened for LAAC.

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“…Anticoagulant agents increase bleeding risk [20] and, although the overall risk may be lower with NOACs when compared with warfarin, it is still nonzero [21]. Although left atrial appendage closure-related scientific societies' recommendations are weak (IIb) [3,4], there is an increasing number of left atrial appendage closure procedures occurring worldwide [22].…”

Section: Discussionmentioning

confidence: 99%

Anticoagulation Status and Left Atrial Appendage Occlusion Indications in Hospitalized Cardiology Patients with Atrial Fibrillation: A Hellenic Cardiorenal Morbidity Snapshot (HECMOS) Sub-Study

Tsiachris,

Papakonstantinou,

Doundoulakis

et al. 2023

Medicina

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Background and Objectives: The proper use of oral anticoagulants is crucial in the management of non-valvular atrial fibrillation (AF) patients. Left atrial appendage closure (LAAC) may be considered for stroke prevention in patients with AF and contraindications for long-term anticoagulant treatment. We aimed to assess anticoagulation status and LAAC indications in patients with AF from the HECMOS (Hellenic Cardiorenal Morbidity Snapshot) survey. Materials and Methods: The HECMOS was a nationwide snapshot survey of cardiorenal morbidity in hospitalized cardiology patients. HECMOS used an electronic platform to collect demographic and clinically relevant information from all patients hospitalized on 3 March 2022 in 55 different cardiology departments. In this substudy, we included patients with known AF without mechanical prosthetic valves or moderate-to-severe mitral valve stenosis. Patients with prior stroke, previous major bleeding, poor adherence to anticoagulants, and end-stage renal disease were considered candidates for LAAC. Results: Two hundred fifty-six patients (mean age 76.6 ± 11.7, 148 males) were included in our analysis. Most of them (n = 159; 62%) suffered from persistent AF. The mean CHA2DS2-VASc score was 4.28 ± 1.7, while the mean HAS-BLED score was 1.47 ± 0.9. Three out of three patients with a a CHA2DS2-VASc score of 0 or 1 (female) were inappropriately anticoagulated. Sixteen out of eighteen patients with a CHA2DS2-VASc score 1 or 2 (if female) received anticoagulants. Thirty-one out of two hundred thirty-five patients with a CHA2DS2-VASc score > 1 or 2 (if female) were inappropriately not anticoagulated. Relative indications for LAAC were present in 68 patients with NVAF (63 had only one risk factor and 5 had two concurrent risk factors). In detail, 36 had a prior stroke, 17 patients had a history of major bleeding, 15 patients reported poor or no adherence to the anticoagulant therapy and 5 had an eGFR value < 15 mL/min/1.73 m2 for a total of 73 risk factors. Moreover, 33 had a HAS-BLED score ≥ 3. No LAAC treatment was recorded. Conclusions: Anticoagulation status was nearly optimal in a high-thromboembolic-risk population of cardiology patients who were mainly treated using NOACs. One out of four AF patients should be screened for LAAC.

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Incidence and cost of bleeding events requiring hospitalization in patients with atrial fibrillation treated with acenocoumarol in Greece

Cited by 5 publications

References 16 publications

Spontaneous Iliopsoas Hematoma in a Patient on Acenocoumarol: Report of a Rare Case

Spontaneous Iliopsoas Hematoma in a Patient on Acenocoumarol: Report of a Rare Case

Anticoagulation Status and Left Atrial Appendage Occlusion Indications in Hospitalized Cardiology Patients with Atrial Fibrillation: A Hellenic Cardiorenal Morbidity Snapshot (HECMOS) Sub-Study

Anticoagulation Status and Left Atrial Appendage Occlusion Indications in Hospitalized Cardiology Patients with Atrial Fibrillation: A Hellenic Cardiorenal Morbidity Snapshot (HECMOS) Sub-Study

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