Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
Research Department of Practice and Policy, UCL School of Pharmacy, London, UK.
J Thromb Haemost. 2017 Oct;15(10):1923-1933. doi: 10.1111/jth.13780. Epub 2017 Aug 17.
Essentials Bleeding is a common cause of hospital admission and readmission in oral anticoagulant users. Patients with dabigatran and warfarin were included to assess hospital admission risk. Dabigatran users had a higher risk of 30-day readmission with bleeding than warfarin users. Close monitoring following hospital discharge for dabigatran-related bleeding is warranted.
Background Reducing 30-day hospital readmission is a policy priority worldwide. Warfarin-related bleeding is among the most common cause of hospital admissions as a result of adverse drug events. Compared with warfarin, dabigatran achieves a full anticoagulation effect more quickly following its initiation; hence it may lead to early-onset bleeds. Objectives To compare the incidence of bleeding-related hospital admissions and 30-day readmissions with dabigatran vs. warfarin in patients with non-valvular atrial fibrillation (NVAF). Methods This was a retrospective cohort study using a population-wide database managed by the Hong Kong Hospital Authority. Patients newly diagnosed with NVAF from 2010 through to 2014 and prescribed dabigatran or warfarin were 1:1 matched by propensity score. The incidence rate of hospital admission with bleeding (a composite of gastrointestinal bleeding, intracranial hemorrhage and bleeding at other sites) was assessed. Results Among the 51 946 patients with NVAF, 8309 users of dabigatran or warfarin were identified, with 5160 patients matched by propensity score. The incidence of first hospitalized bleeding did not differ significantly between groups (incidence rate ratio, 0.92; 95% confidence interval [CI], 0.66-1.28). Among patients who were continuously prescribed their initial anticoagulants upon discharge, dabigatran use was associated with a higher risk of 30-day readmission with bleeding over warfarin (adjusted hazard ratio, 2.87; 95%CI, 1.10-7.43). Conclusion When compared with warfarin, dabigatran was associated with a comparable incidence of first hospital admission but a higher risk of 30-day redmission with respect to bleeding. Close early monitoring of patients initiated on dabigatran following hospital discharge for bleeding is warranted.
Essentials 出血是口服抗凝药物使用者住院和再住院的常见原因。本研究纳入达比加群和华法林使用者，以评估住院风险。与华法林使用者相比，达比加群使用者出血导致 30 天再住院的风险更高。因此，对于达比加群相关出血患者，出院后应密切监测。
背景 减少 30 天住院再入院率是全球的政策重点。华法林相关出血是药物不良反应导致住院的最常见原因之一。与华法林相比，达比加群在起始后更快地达到完全抗凝效果；因此，它可能导致早期出血。目的 比较非瓣膜性心房颤动（NVAF）患者中达比加群与华法林相关出血的住院和 30 天再入院发生率。方法 这是一项回顾性队列研究，使用香港医院管理局管理的人群范围数据库。2010 年至 2014 年新诊断为 NVAF 并接受达比加群或华法林治疗的患者按倾向评分 1:1 匹配。评估出血相关住院（包括胃肠道出血、颅内出血和其他部位出血）的发生率。结果 在 51946 例 NVAF 患者中，确定了 8309 例达比加群或华法林使用者，其中 5160 例按倾向评分匹配。两组首次住院出血的发生率无显著差异（发生率比，0.92；95%置信区间[CI]，0.66-1.28）。在出院时持续服用初始抗凝药物的患者中，达比加群的 30 天出血再入院风险高于华法林（校正风险比，2.87；95%CI，1.10-7.43）。结论 与华法林相比，达比加群首次住院的发生率相当，但出血导致 30 天再入院的风险更高。对于因出血而出院的达比加群使用者，应密切监测早期情况。
