Predictors of oral anticoagulant-associated adverse events in seniors transitioning from hospital to home: a retrospective cohort study protocol

Abstract

IntroductionOral anticoagulants (OACs) are widely prescribed in older adults. High OAC-related adverse event rates in the early period following hospital discharge argue for an analysis to identify predictors. Our objective is to identify and validate clinical and continuity of care variables among seniors discharged from hospital on an OAC, which are independently associated with OAC-related adverse events within 30 days.Methods and analysisWe propose a population-based retrospective cohort study of all adults aged 66 years or older who were discharged from hospital on an OAC from September 2010 to March 2015 in Ontario, Canada. The primary outcome is a composite of the first hospitalisation or emergency department visit for a haemorrhage or thromboembolic event or mortality within 30 days of hospital discharge. A Cox proportional hazards model will be used to determine the association between the composite outcome and a set of prespecified covariates. A split sample method will be adopted to validate the variables associated with OAC-related adverse events.Ethics and disseminationThe use of data in this project was authorised under section 45 of Ontario’s Personal Health Information Protection Act, which does not require review by a research ethics board. Results will be disseminated via peer-reviewed publications and presentations at conferences and will determine intervention targets to improve OAC management in upcoming randomised trials.Trial registration numberClinicalTrials.gov Identifier: NCT02777047; Pre-results.

Anticoagulant use and associated outcomes in older patients receiving home palliative care: a retrospective cohort study

“…We conducted secondary analyses to assess outcomes occurring after the early mortality observation window associated with anticoagulant discontinuation, including thrombotic events (ischemic stroke, transient ischemic attack and venous thromboembolism), [47][48][49] bleeding (intracranial, gastrointestinal [upper or lower], or other [primarily genitourinary and respiratory]), [47][48][49] death and location of death. 8,35 We captured thrombotic and bleeding events using International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) diagnostic codes from hospital admissions and emergency department visits (Appendix 1, Supplemental Table 2).…”

Adverse event rates associated with oral anticoagulant treatment early versus later after hospital discharge in older adults: a retrospective population-based cohort study

“…[58][59][60] We plan to conduct a follow-up study on predictors of our outcome events to address in more detail unmeasured confounding and death as a competing risk of outcomes. 61…”