Pharmacy, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalunya, Spain
Pharmacy, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalunya, Spain.
Eur J Hosp Pharm. 2022 Sep;29(5):271-274. doi: 10.1136/ejhpharm-2020-002426. Epub 2020 Dec 8.
To evaluate the frequency of emergency department (ED) revisits among elderly patients with gastrointestinal bleeding secondary to anticoagulant treatment and identify factors associated with an increased risk of ED revisits.
A 3-year retrospective observational study was designed, including elderly patients (≥65 years) with atrial fibrillation and undergoing oral anticoagulation therapy who visited the ED for gastrointestinal bleeding. To evaluate the risk factors for 30-day revisit, a multivariate analysis was designed including comorbidities, concomitant treatment, change in anticoagulant treatment and prescription of direct-acting oral anticoagulants.
80 patients were included. At discharge, anticoagulation therapy was modified in 21 (26.2%) patients; and changed from an oral anticoagulant to heparin in 17 (21.2%) patients and to another oral anticoagulant in 4 (5.0%) patients. Anticoagulant treatment was withdrawn in 5 (6.3%) patients at discharge. Eleven (13.7%) patients revisited the ED 30 days after hospital discharge for bleeding episodes. No differences in the frequency of revisit to the ED were observed in the patients who changed their anticoagulant treatment at discharge. In the multivariate analysis, chronic kidney disease was the only factor significantly associated with revisits at 30 days.
Elderly patients who experience a first episode of gastrointestinal bleeding have a high risk of revisiting the ED for a bleeding episode, with no particular differences between the types of anticoagulant prescribed at discharge.
评估因抗凝治疗导致胃肠道出血而到急诊科（ED）复诊的老年患者的频率，并确定与 ED 复诊风险增加相关的因素。
设计了一项为期 3 年的回顾性观察研究，纳入因胃肠道出血而到 ED 就诊的老年（≥65 岁）房颤且正在接受口服抗凝治疗的患者。为评估 30 天内复诊的风险因素，进行了多变量分析，包括合并症、伴随治疗、抗凝治疗改变和直接口服抗凝剂的处方。
共纳入 80 例患者。出院时，21 例（26.2%）患者调整了抗凝治疗；17 例（21.2%）患者从口服抗凝剂改为肝素，4 例（5.0%）患者改为另一种口服抗凝剂。出院时，5 例（6.3%）患者停止抗凝治疗。11 例（13.7%）患者在出院后 30 天因出血事件再次到 ED 就诊。出院时改变抗凝治疗的患者，其 ED 复诊频率无差异。多变量分析显示，慢性肾脏病是唯一与 30 天内复诊相关的因素。
首次发生胃肠道出血的老年患者再次因出血事件到 ED 就诊的风险较高，出院时所开的抗凝剂类型之间无明显差异。
