Department of Cardiovascular Diseases, University Hospital Dubrava, 10000, Zagreb, Croatia.
Department of Diabetes, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Dugi dol 4a, 10000, Zagreb, Croatia.
High Blood Press Cardiovasc Prev. 2024 Jan;31(1):23-30. doi: 10.1007/s40292-023-00616-y. Epub 2024 Jan 8.
Safety studies of anticoagulant therapy have so far been conducted on many subjects in controlled conditions (i.e., clinically monitored) and demonstrated the noninferiority of new ones over old anticoagulant drugs. Data on the propositions for the presence of symptoms and signs of bleeding among various anticoagulants in the emergency department indicate that these data do not match the data published so far.
The aim of the study was to investigate the differences in the frequency of bleeding and bleeding-related symptoms as a reason for emergency department attendance in patients on anticoagulant therapy.
The study included patients from the emergency department of University Hospital for one year, who were on anticoagulant therapy and who met the inclusion criteria. Out of a total of 595 patients, 409 were on warfarin (68.74%), and the rest were taking direct oral anticoagulants (DOAC): dabigatran 71 (11.93%), rivaroxaban 66 (11.09%) and apixaban 49 (8.23%).
Out of 409 patients taking warfarin, 34.4% were adequately anticoagulated with the frequency of bleeding 13.7%, while in 57.2% of patients, PT INR was higher than the reference values with the frequency of bleeding 15.0%. A comparison between all DOAC groups and adequately anticoagulated warfarin patients in the frequency of bleeding and bleeding-related symptoms as a reason for emergency attendance yielded a difference that was marginally statistically significant (Pearson Chi-Square = 7.554, p = 0.052).
Monitoring the frequency of bleeding and bleeding-related symptoms in patients on oral anticoagulant therapy as a reason for emergency department attendance may be a new safety and efficacy factor in real-life patient scenarios.
抗凝治疗的安全性研究迄今为止已在许多受控条件（即临床监测）下的受试者中进行，并证明了新型抗凝药物优于旧抗凝药物。关于各种抗凝剂在急诊科出现症状和体征的出血的报告数据表明，这些数据与迄今为止发表的数据不匹配。
本研究旨在调查在接受抗凝治疗的患者中，因出血和出血相关症状而导致急诊科就诊的频率差异。
这项研究纳入了在大学医院急诊科接受抗凝治疗且符合纳入标准的患者，为期一年。在总共 595 名患者中，409 名服用华法林（68.74%），其余服用直接口服抗凝剂（DOAC）：达比加群 71 名（11.93%）、利伐沙班 66 名（11.09%）和阿哌沙班 49 名（8.23%）。
在服用华法林的 409 名患者中，34.4%的患者抗凝充分，出血频率为 13.7%，而在 57.2%的患者中，PT INR 高于参考值，出血频率为 15.0%。将所有 DOAC 组与充分抗凝的华法林患者进行比较，出血频率和出血相关症状作为急诊科就诊的原因，差异具有边缘统计学意义（Pearson Chi-Square = 7.554，p = 0.052）。
监测口服抗凝治疗患者因出血和出血相关症状而导致急诊科就诊的频率可能是真实患者场景中的一个新的安全性和疗效因素。
