Hanna Fayez, Hyppa Annemarie, Prakash Ajay, Vithanarachchi Usira, Dawar Hizb U, Sanga Zar, Olabode George, Crisp Hamish, Khalafallah Alhossain A
Faculty of Health Sciences, Launceston, University of Tasmania, Tasmania, 7249, Australia.
Department of Haematology, Specialist Care Australia, Launceston, Tasmania, 7250 Australia.
Mediterr J Hematol Infect Dis. 2021 Mar 1;13(1):e2021017. doi: 10.4084/MJHID.2021.017. eCollection 2021.
To study patients receiving anticoagulants with or without antiplatelet therapy presenting at a regional Australian hospital with bleeding. The main aims are to explore: (1) patients' characteristics and management provided; (2) association between the type of anticoagulant and antiplatelet agent used and the requirement of reversal; (3) and the length of hospital stay (LoS) in conjunction with bleeding episode and management.
A prospective cross-sectional review of medical records of all patients who presented at a tertiary referral centre with bleeding while receiving anticoagulation therapy between January 2016 and June 2018. Data included: patients, demographics, investigations (kidney and liver function tests, coagulation profile, FBC), LoS, bleeding site, type of and reason for anticoagulation therapy, and management provided. Data analysis included descriptive statistics, χ association, and regression models.
Among the 144 eligible patients, 75 (52.1%) were male, and the mean age was 76 years (=11.1). Gastrointestinal tract bleeding was the most common (=48, 33.3%), followed by epistaxis (=32, 22.2%). Atrial fibrillation was the commonest reason for anticoagulation therapy (=65, 45.1%). Warfarin was commonly used (=74, 51.4%), followed by aspirin =29, 20.1%), rivaroxaban (=26, 18.1%), and apixaban (=12, 8.3%). The majority had increased blood urea nitrogen (=67, 46.5%), while 58 (40.3%) had an elevated serum creatinine level, and 59 (41.0%) had a mild reduction in eGFR. Thirty-five of the warfarinised patients (47.3%) had an INR above their condition's target range despite normal liver function. Severe anaemia (Hb<80g/L) was reported in 88 patients (61.1%). DOACs were associated with a reduced likelihood of receiving reversal (= -1.7, =<.001), and with a shorter LoS (= -4.1, P=.046) when compared with warfarin, LMWH, and antiplatelet therapy.
Warfarin use was common among patients who presented with acute bleeding, and the INR in many warfarinised patients exceeded the target for their condition. DOACs were associated with a reduced likelihood of receiving reversal and a shorter LoS than warfarin, LMWH, which might support a broader application of DOACs into community practice.
研究在澳大利亚一家地区医院接受抗凝治疗（无论是否联合抗血小板治疗）且出现出血症状的患者。主要目的是探讨：（1）患者特征及所接受的治疗；（2）所使用的抗凝剂和抗血小板药物类型与逆转治疗需求之间的关联；（3）以及住院时间（LoS）与出血事件及治疗的关系。
对2016年1月至2018年6月期间在一家三级转诊中心接受抗凝治疗时出现出血症状的所有患者的病历进行前瞻性横断面回顾。数据包括：患者、人口统计学信息、检查（肾功能和肝功能测试、凝血指标、全血细胞计数）、住院时间、出血部位、抗凝治疗的类型及原因，以及所提供的治疗。数据分析包括描述性统计、χ²关联分析和回归模型。
在144例符合条件的患者中，75例（52.1%）为男性，平均年龄为76岁（标准差 = 11.1）。胃肠道出血最为常见（48例，33.3%），其次是鼻出血（32例，22.2%）。心房颤动是抗凝治疗最常见的原因（65例，45.1%）。华法林使用最为普遍（74例，51.4%），其次是阿司匹林（29例，20.1%）、利伐沙班（26例，18.1%）和阿哌沙班（12例，8.3%）。大多数患者血尿素氮升高（67例，46.5%），而58例（40.3%）血清肌酐水平升高，59例（41.0%）估算肾小球滤过率轻度降低。35例服用华法林的患者（47.3%）尽管肝功能正常，但国际标准化比值（INR）高于其病情的目标范围。88例患者（61.1%）报告有严重贫血（血红蛋白<80g/L）。与华法林、低分子肝素和抗血小板治疗相比，直接口服抗凝剂（DOACs）接受逆转治疗的可能性降低（比值比 = -1.7，P<0.001），且住院时间较短（差值 = -4.1，P = 0.046）。
在出现急性出血的患者中，华法林的使用较为普遍，许多服用华法林的患者INR超过其病情的目标值。与华法林、低分子肝素相比，DOACs接受逆转治疗的可能性降低且住院时间较短，这可能支持DOACs在社区实践中的更广泛应用。
