Pre-hospital use of direct oral anticoagulants agents is associated with a lower risk of major bleeding events in critically ill patients: A single academic center experience

被引:1
|
作者
Lal, Amos [1 ]
Wahab, Abdul [2 ]
Tekin, Aysun [1 ]
Lahori, Simmy [3 ]
Park, John G. [1 ]
机构
[1] Mayo Clin, Dept Med, Div Pulm & Crit Care Med, Rochester, MN 55905 USA
[2] Mayo Clin Hlth Syst, Div Hosp Med, Mankato, MN USA
[3] Mayo Clin, Dept Radiol, Rochester, MN USA
来源
HEART & LUNG | 2023年 / 62卷
关键词
Intensive care unit; Critical care; Anticoagulation; DOACs; Bleeding; Warfarin; Transfusion; MORTALITY RISKS; WARFARIN; RIVAROXABAN; DABIGATRAN; SAFETY; APIXABAN; STROKE;
D O I
10.1016/j.hrtlng.2023.08.008
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: The last decade has witnessed significant advancements in direct oral anticoagulants (DOACs), transforming the landscape of anticoagulation therapy. With the uptrend in DOACs use, critical care physicians are encountering more patients with pre-hospital DOACs prescription. Safety and real world outcomes-related data on DOACs use in critically ill patients are scarce. Objective: We assess the risk of major bleeding (MB) events and patient-centered outcomes with pre-hospital use of direct oral anticoagulant agents (DOACs) compared to warfarin therapy. Methods: Observational study in a single large academic center from January 1st, 2012, through May 4th, 2018. We included adult critically ill patients with warfarin or one of the DOACs, as active medications at the time of hospital admission. The primary outcome was major bleeding (MB), based on the ISTH criteria Results: 99,481 patients were screened; 558 and 3037 patients were included in the final analysis for the DOAC and warfarin groups, respectively. Multivariable analysis showed that the pre-hospital use of DOACs was associated with lower odds for major bleeding events, GI bleeding, need for endoscopic intervention, hemorrhagic shock, any blood transfusion; but higher odds of intracranial bleeding, as compared to warfarin use. There was no difference in hospital length of stay or ICU-free days. Conclusions: Pre-hospital use of DOACs among critically ill patients is associated with lower major bleeding events, GI bleeding, need for endoscopic intervention, and blood transfusion but a higher risk for intracranial bleeding.
引用
收藏
页码:264 / 270
页数:7
相关论文
共 31 条
  • [21] Prevalence and bleeding risk associated with the concomitant use of direct oral anticoagulants and antiarrhythmic drugs in patients with atrial fibrillation, based on the French healthcare insurance database
    Gosselin, Laetitia
    Vilcu, Ana-Maria
    Souty, Cecile
    Steichen, Olivier
    Launay, Titouan
    Conte, Cecile
    Saint-Salvi, Beatrice
    Turbelin, Clement
    Sarazin, Marianne
    Blanchon, Thierry
    Hanslik, Thomas
    Lapeyre-Mestre, Maryse
    Rossignol, Louise
    EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY, 2023, 79 (07) : 937 - 945
  • [22] Prevalence and bleeding risk associated with the concomitant use of direct oral anticoagulants and antiarrhythmic drugs in patients with atrial fibrillation, based on the French healthcare insurance database
    Laëtitia Gosselin
    Ana-Maria Vilcu
    Cécile Souty
    Olivier Steichen
    Titouan Launay
    Cécile Conte
    Béatrice Saint-Salvi
    Clément Turbelin
    Marianne Sarazin
    Thierry Blanchon
    Thomas Hanslik
    Maryse Lapeyre-Mestre
    Louise Rossignol
    European Journal of Clinical Pharmacology, 2023, 79 : 937 - 945
  • [23] Prevalence and bleeding risk associated with the concomitant use of direct oral anticoagulants and antiarrhythmic drugs in patients with atrial fibrillation, based on the French healthcare insurance database
    Gosselin, L.
    Vilcu, A. M.
    Souty, C.
    Steichen, O.
    Launay, T.
    Conte, C.
    Saint-Salvi, B.
    Turbelin, C.
    Sarazin, M.
    Blanchon, T.
    Hanslik, T.
    Lapeyre-Mestre, M.
    Rossignol, L.
    FUNDAMENTAL & CLINICAL PHARMACOLOGY, 2022, 36 : 24 - 24
  • [24] Risk of major bleeding associated with the use of direct oral anticoagulants compared to vitamin K antagonists in patients with atrial fibrillation: A European multi-country population-based cohort study
    Souverein, Patrick C.
    Van den Ham, Hendrika A.
    Huerta, Consuelo
    Martin Merino, Elisa
    Montero, Dolores
    Leon-Munoz, Luz M.
    Schmiedl, Sven
    Rottenkolber, Marietta
    Andersen, Morten
    Aakjaer, Mia
    De Bruin, Marie L.
    Klungel, Olaf H.
    Gardarsdottir, Helga
    PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, 2019, 28 : 553 - 553
  • [25] Risk of major bleeding and stroke associated with the use of vitamin K antagonists, nonvitamin K antagonist oral anticoagulants and aspirin in patients with atrial fibrillation: a cohort study
    Gieling, Emilie M.
    van den Ham, Hendrika A.
    van Onzenoort, Hein
    Bos, Jacqueline
    Kramers, Cornelis
    de Boer, Anthonius
    de Vries, Frank
    Burden, Andrea M.
    BRITISH JOURNAL OF CLINICAL PHARMACOLOGY, 2017, 83 (08) : 1844 - 1859
  • [26] Clinical factors associated with the use of NIV in the pre-hospital setting in adult patients treated for acute COPD exacerbation: a single-center retrospective cohort study
    von During, Stephan
    Chevalley, Benjamin
    Wozniak, Hannah
    Desmettre, Thibaut
    Quintard, Herve
    Suppan, Laurent
    Fehlmann, Christophe A.
    BMC EMERGENCY MEDICINE, 2025, 25 (01):
  • [27] LOWER ADHERENCE DIRECT ORAL ANTICOAGULANTS USE IS ASSOCIATED WITH INCREASED RISK OF THROMBOEMBOLIC EVENTS THAN WARFARIN - UNDERSTANDING THE REAL-WORLD PERFORMANCE OF SYSTEMIC ANTICOAGULATION IN ATRIAL FIBRILLATION
    Lakkireddy, Dhanunjaya R.
    Karst, Edward
    Mahapatra, Srijoy
    Winterfield, Jeffrey R.
    Mansour, Moussa
    HEART RHYTHM, 2018, 15 (06) : 943 - 943
  • [28] Concomitant Use of Direct Oral Anticoagulants and Pharmacokinetically-Interacting Antiarrhythmics and the Risk of Major Bleeding in Patients with Non-Valvular Atrial Fibrillation: Population-Based Cohort Study
    Meinert, Fabian Maximilian
    Dimakos, Jenny
    Cui, Ying
    Filion, Kristian B.
    Renoux, Christel
    Douros, Antonios
    PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, 2024, 33 : 134 - 135
  • [29] Real-world comparison of major bleeding risk associated with direct oral anticoagulants or warfarin in patients with non-valvular atrial fibrillation: a systematic review and network meta-analysis
    Deitelzweig, S. B.
    Farmer, C.
    Luo, X.
    Li, X.
    Vo, L.
    Mardekian, J.
    Fahrbach, K.
    Ashaye, A.
    EUROPEAN HEART JOURNAL, 2017, 38 : 577 - 578
  • [30] Risk of major bleeding associated with the use of individual direct oral anticoagulants compared to vitamin K antagonists in patients with non-valvular atrial fibrillation: a meta-analysis of results from multiple population-based cohort studies using a common protocol in Europe and Canada
    van den Ham, Hendrika
    Souverein, Patrick
    Klungel, Olaf
    Platt, Robert
    Ernst, Pierre
    Dell'Aniello, Sophie
    Schmiedl, Sven
    Grave, Birgit
    Rottenkolber, Marietta
    Huerta, Consuelo
    Martin Merino, Elisa
    Leon-Munoz, Luz
    Montero, Dolores
    Andersen, Morten
    Aakjaer, Mia
    De Bruin, Marieke
    Gardarsdottir, Helga
    PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, 2019, 28 : 410 - 411