From the Emergency Department, Apuane General Hospital, Massa-Carrara, Italy.
Apuane General Hospital, Internal and Geriatric Medicine, Massa-Carrara, Italy.
Crit Pathw Cardiol. 2020 Sep;19(3):131-138. doi: 10.1097/HPC.0000000000000205.
To investigate the risk of bleeding events in older patients under oral anticoagulant with a 4-year survey of a catchment area with 197,722 inhabitants of whom 15,267 were on warfarin and 10,397 on direct oral anticoagulants (DOACs).
Patients presented to the Emergency Department with major bleeding were enrolled and stratified according to age ≥75 years and ongoing warfarin or DOACs. Primary endpoint was 1-month death.
Out of 1919 major bleeding, those of patients ≥75 years of age were 1127 (59%) versus 792 (41%) <75 years of age, P < 0.0001. In patients ≥75 years of age, brain hemorrhage accounted for 612 (54%) patients, gastrointestinal hemorrhage for 301 (27%), hematuria for 104 (9%), and other hemorrhage for 108 (10%). In patients ≥75 years of age, those on warfarin accounted for 175 versus 53 on DOACs, without difference of Charlson Comorbidity Index (5.25 ± 1.92 versus 5.09 ± 1.61; P = 0.5824). One-month death in patients ≥75 of age versus <75 years of age accounted for 77 (4.0%) versus 20 (1.0%); P < 0.0001. One-month death in patients ≥75 of age on DOACs was very low, without difference versus <75 years and within DOACs. Among DOACs, absolute bleeding events showed differences as follows: 3 bleeding events for edoxaban versus 21 for dabigatran; P < 0.001; versus 16 for rivaroxaban, P = 0.006; and versus 13 for apixaban, P = 0.02.
Major bleeding and 1-month death accounted for higher percentage in patients ≥75 years of age and in patients receiving warfarin. Among DOACs, edoxaban presented the lowest absolute rate of hemorrhage among the 4 available DOACs, without difference in mortality.
通过对一个拥有 197722 名居民的流域的 4 年调查，研究口服抗凝剂老年患者出血事件的风险，该流域中有 15267 名患者服用华法林，10397 名患者服用直接口服抗凝剂（DOACs）。
将因大出血就诊于急诊科的患者纳入研究，并根据年龄≥75 岁和持续服用华法林或 DOACs 进行分层。主要终点为 1 个月内死亡。
在 1919 例大出血患者中，年龄≥75 岁的患者为 1127 例（59%），年龄<75 岁的患者为 792 例（41%），P<0.0001。在年龄≥75 岁的患者中，脑出血占 612 例（54%），胃肠道出血占 301 例（27%），血尿占 104 例（9%），其他出血占 108 例（10%）。在年龄≥75 岁的患者中，服用华法林的患者为 175 例，服用 DOACs 的患者为 53 例，Charlson 合并症指数无差异（5.25±1.92 与 5.09±1.61；P=0.5824）。年龄≥75 岁的患者 1 个月内死亡率为 77 例（4.0%），年龄<75 岁的患者为 20 例（1.0%）；P<0.0001。年龄≥75 岁的 DOACs 患者的 1 个月内死亡率非常低，与<75 岁的患者相比无差异，且在 DOACs 内也无差异。在 DOACs 中，绝对出血事件如下所示：依度沙班有 3 例出血事件，达比加群有 21 例；P<0.001；与利伐沙班有 16 例，P=0.006；与阿哌沙班有 13 例，P=0.02。
年龄≥75 岁的患者以及服用华法林的患者中，大出血和 1 个月内死亡率的比例更高。在 DOACs 中，依度沙班在 4 种可用的 DOACs 中出血的绝对发生率最低，死亡率无差异。
