Deitelzweig, Steven, Keshishian, Allison, Kang, Amiee, Dhamane, Amol D, Luo, Xuemei, Balachander, Neeraja, Rosenblatt, Lisa, Mardekian, Jack, Jiang, Jenny, Yuce, Huseyin et al (show 1 more authors)
(2021)
Burden of major gastrointestinal bleeding among oral anticoagulant-treated non-valvular atrial fibrillation patients.
THERAPEUTIC ADVANCES IN GASTROENTEROLOGY, 14.
1756284821997352-.
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Abstract
<h4>Background</h4>Gastrointestinal (GI) bleeding is the most common type of major bleeding associated with oral anticoagulant (OAC) treatment. Patients with major bleeding are at an increased risk of a stroke if an OAC is not reinitiated.<h4>Methods</h4>Non-valvular atrial fibrillation (NVAF) patients initiating OACs were identified from the <i>Centers for Medicare and Medicaid Services</i> (<i>CMS</i>) Medicare data and four US commercial claims databases. Patients who had a major GI bleeding event (hospitalization with primary diagnosis of GI bleeding) while on an OAC were selected. A control cohort of patients without a major GI bleed during OAC treatment was matched to major GI bleeding patients using propensity scores. Stroke/systemic embolism (SE), major bleeding, and mortality (in the CMS population) were examined using Cox proportional hazards models with robust sandwich estimates.<h4>Results</h4>A total of 15,888 patients with major GI bleeding and 833,052 patients without major GI bleeding were included in the study. Within 90 days of the major GI bleed, 58% of patients discontinued the initial OAC treatment. Patients with a major GI bleed had a higher risk of stroke/SE [hazard ratio (HR): 1.57, 95% confidence interval (CI): 1.42-1.74], major bleeding (HR: 2.79, 95% CI: 2.64-2.95), and all-cause mortality (HR: 1.29, 95% CI: 1.23-1.36) than patients without a major GI bleed.<h4>Conclusion</h4>Patients with a major GI bleed on OAC had a high rate of OAC discontinuation and significantly higher risk of stroke/SE, major bleeding, and mortality after hospital discharge than those without. Effective management strategies are needed for patients with risk factors for major GI bleeding.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | atrial fibrillation, gastrointestinal bleeding, major bleeding, oral anticoagulants, stroke |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 26 Sep 2023 14:37 |
| Last Modified: | 26 Sep 2023 14:37 |
| DOI: | 10.1177/1756284821997352 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3173085 |
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