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Minor bleeding in patients with atrial fibrillation using a non-vitamin-K antagonist oral anticoagulant.
Curr Med Res Opin. 2020 Jul 31 [Online ahead of print]CM

Abstract

AIMS

We sought to investigate the magnitude of minor bleeding and identify risk factors for minor bleeds during non-vitamin-K antagonist oral anticoagulant (NOAC) therapy.

METHODS

This was an observational cohort study of patients with atrial fibrillation (AF) referred to a regional NOAC outpatient clinic between February 2013 and October 2017. The study population consisted of 875 consecutive patients with AF who visited the NOAC outpatient unit to initiate treatment with apixaban (N = 303), dabigatran (N = 267) or rivaroxaban (N = 305) for long-term ischemic stroke prophylaxis. Minor bleed was defined as every overt bleeding that does not fulfil the criteria of major or non-major clinically relevant bleeding according to the International Society on Thrombosis and Haemostasis.

RESULTS

Overall rate of minor bleeds was 19.2 per 100 patient years of follow-up. Bleeding rates for apixaban, dabigatran and rivaroxaban were 26, 8.3 and 23 per 100 patient-years of follow-up. Next to the type of NOAC, the main risk indicators for minor bleedings during NOAC therapy were a HAS-BLED score of 3 or higher and novel anticoagulant use (no history of vitamin K antagonist use).

LIMITATION

This was a retrospective observational study evaluating NOAC treatment in a non-randomized setting.

CONCLUSION

Our data showed that minor bleeds are common in novel NOAC users, especially when using apixaban and rivaroxaban. In the latter two NOACs, hematoma (bruises) and nose bleeds were more frequently observed and accounted for the difference with dabigatran. Besides type of NOAC, a higher HAS-BLED score and novel anticoagulant drug use were associated with an increased risk of minor bleeding.

Authors+Show Affiliations

Department of Hospital Pharmacy, Tjongerschans, Heerenveen, The Netherlands.Department of Cardiology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands. Department of Clinical Pharmacy, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.Department of Clinical Pharmacy, Medical Centre Leeuwarden, Leeuwarden, The Netherlands. Department of Pharmacotherapy, Epidemiology and Economy, Faculty Pharmacy, University of Groningen, Groningen, The Netherlands.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32573287

Citation

Mitrovic, Darko, et al. "Minor Bleeding in Patients With Atrial Fibrillation Using a non-vitamin-K Antagonist Oral Anticoagulant." Current Medical Research and Opinion, 2020, pp. 1-6.
Mitrovic D, Folkeringa R, Veeger N, et al. Minor bleeding in patients with atrial fibrillation using a non-vitamin-K antagonist oral anticoagulant. Curr Med Res Opin. 2020.
Mitrovic, D., Folkeringa, R., Veeger, N., & van Roon, E. (2020). Minor bleeding in patients with atrial fibrillation using a non-vitamin-K antagonist oral anticoagulant. Current Medical Research and Opinion, 1-6. https://doi.org/10.1080/03007995.2020.1786808
Mitrovic D, et al. Minor Bleeding in Patients With Atrial Fibrillation Using a non-vitamin-K Antagonist Oral Anticoagulant. Curr Med Res Opin. 2020 Jul 31;1-6. PubMed PMID: 32573287.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Minor bleeding in patients with atrial fibrillation using a non-vitamin-K antagonist oral anticoagulant. AU - Mitrovic,Darko, AU - Folkeringa,Richard, AU - Veeger,Nic, AU - van Roon,Eric, Y1 - 2020/07/31/ PY - 2020/6/24/pubmed PY - 2020/6/24/medline PY - 2020/6/24/entrez KW - NOAC KW - anticoagulants KW - apixaban KW - dabigatran KW - minor bleeding KW - rivaroxaban SP - 1 EP - 6 JF - Current medical research and opinion JO - Curr Med Res Opin N2 - AIMS: We sought to investigate the magnitude of minor bleeding and identify risk factors for minor bleeds during non-vitamin-K antagonist oral anticoagulant (NOAC) therapy. METHODS: This was an observational cohort study of patients with atrial fibrillation (AF) referred to a regional NOAC outpatient clinic between February 2013 and October 2017. The study population consisted of 875 consecutive patients with AF who visited the NOAC outpatient unit to initiate treatment with apixaban (N = 303), dabigatran (N = 267) or rivaroxaban (N = 305) for long-term ischemic stroke prophylaxis. Minor bleed was defined as every overt bleeding that does not fulfil the criteria of major or non-major clinically relevant bleeding according to the International Society on Thrombosis and Haemostasis. RESULTS: Overall rate of minor bleeds was 19.2 per 100 patient years of follow-up. Bleeding rates for apixaban, dabigatran and rivaroxaban were 26, 8.3 and 23 per 100 patient-years of follow-up. Next to the type of NOAC, the main risk indicators for minor bleedings during NOAC therapy were a HAS-BLED score of 3 or higher and novel anticoagulant use (no history of vitamin K antagonist use). LIMITATION: This was a retrospective observational study evaluating NOAC treatment in a non-randomized setting. CONCLUSION: Our data showed that minor bleeds are common in novel NOAC users, especially when using apixaban and rivaroxaban. In the latter two NOACs, hematoma (bruises) and nose bleeds were more frequently observed and accounted for the difference with dabigatran. Besides type of NOAC, a higher HAS-BLED score and novel anticoagulant drug use were associated with an increased risk of minor bleeding. SN - 1473-4877 UR - https://www.unboundmedicine.com/medline/citation/32573287/Minor_bleeding_in_patients_with_atrial_fibrillation_using_a_non-vitamin_K_antagonist_oral_anticoagulant L2 - http://www.tandfonline.com/doi/full/10.1080/03007995.2020.1786808 DB - PRIME DP - Unbound Medicine ER -
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