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Seidu S, Gillies C, Zaccardi F, Reeves K, Gallier S, Khunti K. Temporal trends in admissions for atrial fibrillation and severe bleeding in England: an 18-year longitudinal analysis. Scand Cardiovasc J Suppl 2023; 57:40-47. [PMID: 36519374 DOI: 10.1080/14017431.2022.2156597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objective. Temporal trends in admissions for atrial fibrillation (AF) and severe bleeding associated with AF vary worldwide. We aimed to explore their temporal trends in England and their relation to the introduction of DOACs in 2014 in the UK. Design. This longitudinal ecological study utilised aggregated data that was extracted from the Hospital Episode Statistics database, which captured annual admissions for AF and severe bleeding associated with AF between 2001 and 2018. Trends in admissions over the study period and across age groups, gender and regions in England were assessed. Results. In total, there were 11,292,177 admissions for AF and 324,851 admissions for severe bleeding associated with AF. There was a steady rise in admissions for AF from 2001 to 2017 (204,808 to 1,109,295; p for trend<.001). A similar trend was observed for severe bleeding (4940 to 30,169; p for trend <.001), but the increase dropped slightly between 2013 and 2014 and continued thereafter. Conclusions. There was a rise in admissions for AF and severe bleeding in England between 2001 and 2018. There is little evidence that the slight drop in admissions for severe bleeding between 2013 and 2014 may have been caused by the introduction of DOACs in 2014. Contributors to these trends need urgent exploration.
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Affiliation(s)
- Samuel Seidu
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK.,Real World Evidence Unit, University of Leicester, Leicester, UK
| | - Clare Gillies
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK.,Real World Evidence Unit, University of Leicester, Leicester, UK
| | - Francesco Zaccardi
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK.,Real World Evidence Unit, University of Leicester, Leicester, UK
| | - Katharine Reeves
- Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; dInstitute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Suzy Gallier
- Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; dInstitute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK.,Real World Evidence Unit, University of Leicester, Leicester, UK
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Marco Garbayo JL, Koninckx Cañada M, Pérez Castelló I, Faus Soler MT, Perea Ribis M. Hospital admissions for bleeding events associated with treatment with apixaban, dabigatran and rivaroxaban. Eur J Hosp Pharm 2017; 26:106-112. [PMID: 31157109 DOI: 10.1136/ejhpharm-2017-001390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 09/22/2017] [Accepted: 10/10/2017] [Indexed: 12/30/2022] Open
Abstract
Objectives To analyse the hospital admissions for bleeding events associated with treatment with direct oral anticoagulants (DOACs). To describe the characteristics and outcomes of those patients. Methods A retrospective observational study was carried out in the framework of an integral risk management plan of drugs and proactive pharmacovigilance of hospital admissions for bleeding associated with apixaban, dabigatran and rivaroxaban from April 2015 through December 2016. Cases were identified using the information management tool of Orion Clinic (hospital electronic medical history) and by reviewing the hospital discharge reports. Various biometric, clinical and pharmacotherapeutic variables of each patient were registered. Results 37 hospitalisation episodes for DOAC-induced bleeding in 32 patients (15 received rivaroxaban, 9 apixaban and 8 dabigatran) were detected, representing an incidence rate of 3.44 per 100 person-years (95% CI 2.35 to 4.86). The most common bleeding site was gastrointestinal (27 cases, 73.0%). Intracranial bleeding was rare (three cases, 8.1%). Four patients (12.5%) were receiving DOACs at full doses and had a 'dose reduction indication'. The mean (SD) length of stay was 8.4 (5.2) days. Three patients (8.1%) died during the hospitalisation. Among bleeding episodes without fatal outcome, DOACs were stopped in 14 cases, continued in 14 cases, switched for another DOAC in two cases and the dose was reduced in four cases. Conclusions DOACs are associated with serious bleeding events that require hospitalisation. The risk/benefit ratio assessment considering patient preferences and an individualised follow-up, especially in patients who are elderly, polymedicated or have impaired renal function, can help to reinforce the safe use of DOACs.
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Affiliation(s)
- José Luis Marco Garbayo
- Department of Hospital Pharmacy, Francesc de Borja Hospital of Gandia, Gandia, Valencia, Spain
| | - Manuel Koninckx Cañada
- Department of Hospital Pharmacy, Francesc de Borja Hospital of Gandia, Gandia, Valencia, Spain
| | - Isabel Pérez Castelló
- Department of Hospital Pharmacy, Francesc de Borja Hospital of Gandia, Gandia, Valencia, Spain
| | - María Teresa Faus Soler
- Department of Hospital Pharmacy, Francesc de Borja Hospital of Gandia, Gandia, Valencia, Spain
| | - Mariam Perea Ribis
- Department of Internal Medicine, Francesc de Borja Hospital of Gandia, Gandia, Valencia, Spain
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Hogg K, Bahl B, Latrous M, Scaffidi Argentina S, Thompson J, Chatha AA, Castellucci L, Stiell IG. Time trends in intracranial bleeding associated with direct oral anticoagulants: a 5-year cohort study. CMAJ Open 2015; 3:E432-7. [PMID: 26770966 PMCID: PMC4701652 DOI: 10.9778/cmajo.20150037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Over the past 5 years, dabigatran, rivaroxaban and apixaban were approved for stroke prevention. Phase III studies have shown a lower risk of intracranial bleeding with these direct oral anticoagulants than with warfarin; however, there is a lack of real-life data to validate this. We analyzed time trends in atraumatic intracranial bleeding from 2009 to 2013 among patients prescribed oral anticoagulants and those not prescribed oral anticoagulants. METHODS We used ICD-10-CA (enhanced Canadian version of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems) codes to identify all patients with atraumatic intracranial bleeding who presented to our neurosurgical centre (serving a population of more than 1.2 million). Trained researchers extracted data on anticoagulant medications used in the week before diagnosis of the intracranial bleed. Provincial prescription data for oral anticoagulants were obtained from IMS Brogan CompuScript Market Dynamics. The primary outcome was the time trend in incident intracranial bleeds associated with oral anticoagulation during the period 2009-2013. The secondary outcomes were the time trend in intracranial bleeds not associated with oral anticoagulation and the provincial prescribing patterns for oral anticoagulants during the same period. RESULTS A total of 2050 patients presented with atraumatic intracranial bleeds during the study period. Of the 371 (18%) prescribed an anticoagulant in the week before presentation, 335 were prescribed an oral anticoagulant. There was an increasing time trend in intracranial bleeding associated with oral anticoagulants (p = 0.009; 6 additional events per year) and in intracranial bleeding not associated with oral anticoagulation (p = 0.06). During 2013, prescriptions for warfarin decreased to 70% of all oral anticoagulant prescriptions in the province, whereas those for dabigatran and rivaroxaban increased to 17% and 12%, respectively. INTERPRETATION We observed increasing time trends in intracranial bleeding, both associated with and not associated with oral anticoagulants, over the study period. Although aggregate provincial data showed increased prescribing of oral anticoagulants, other more likely explanations for our findings include an aging population or increasing frailty.
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Affiliation(s)
- Kerstin Hogg
- Department of Emergency Medicine (Bahl), Scarborough Hospital, Scarborough, Ont.; Department of Emergency Medicine (Hogg, Latrous, Scaffidi Argentina, Thompson, Chatha, Stiell) and Department of Medicine (Castellucci), University of Ottawa, Ottawa, Ont
| | - Bharat Bahl
- Department of Emergency Medicine (Bahl), Scarborough Hospital, Scarborough, Ont.; Department of Emergency Medicine (Hogg, Latrous, Scaffidi Argentina, Thompson, Chatha, Stiell) and Department of Medicine (Castellucci), University of Ottawa, Ottawa, Ont
| | - Meriem Latrous
- Department of Emergency Medicine (Bahl), Scarborough Hospital, Scarborough, Ont.; Department of Emergency Medicine (Hogg, Latrous, Scaffidi Argentina, Thompson, Chatha, Stiell) and Department of Medicine (Castellucci), University of Ottawa, Ottawa, Ont
| | - Sarina Scaffidi Argentina
- Department of Emergency Medicine (Bahl), Scarborough Hospital, Scarborough, Ont.; Department of Emergency Medicine (Hogg, Latrous, Scaffidi Argentina, Thompson, Chatha, Stiell) and Department of Medicine (Castellucci), University of Ottawa, Ottawa, Ont
| | - Jesse Thompson
- Department of Emergency Medicine (Bahl), Scarborough Hospital, Scarborough, Ont.; Department of Emergency Medicine (Hogg, Latrous, Scaffidi Argentina, Thompson, Chatha, Stiell) and Department of Medicine (Castellucci), University of Ottawa, Ottawa, Ont
| | - Aasil Ayyaz Chatha
- Department of Emergency Medicine (Bahl), Scarborough Hospital, Scarborough, Ont.; Department of Emergency Medicine (Hogg, Latrous, Scaffidi Argentina, Thompson, Chatha, Stiell) and Department of Medicine (Castellucci), University of Ottawa, Ottawa, Ont
| | - Lana Castellucci
- Department of Emergency Medicine (Bahl), Scarborough Hospital, Scarborough, Ont.; Department of Emergency Medicine (Hogg, Latrous, Scaffidi Argentina, Thompson, Chatha, Stiell) and Department of Medicine (Castellucci), University of Ottawa, Ottawa, Ont
| | - Ian G Stiell
- Department of Emergency Medicine (Bahl), Scarborough Hospital, Scarborough, Ont.; Department of Emergency Medicine (Hogg, Latrous, Scaffidi Argentina, Thompson, Chatha, Stiell) and Department of Medicine (Castellucci), University of Ottawa, Ottawa, Ont
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