MAJOR BLEEDING IN PATIENTS ON TREATMENT WITH NOAC OR VKA IN REAL-LIFE: CLINICAL PRESENTATION, MANAGEMENT AND OUTCOME
Author(s): ,
Laura Franco
Affiliations:
University Of Perugia,PERUGIA,Italy
,
Cecilia Becattini
Affiliations:
University Of Perugia,PERUGIA,Italy
,
Jan Beyer-Westendorf
Affiliations:
Technische Universität Dresden,Dresden,Germany
,
Luca Masotti
Affiliations:
Internal Medicine,Santa Maria Nuova Hospital,Firenze,Italy
,
Cinzia Nitti
Affiliations:
Emergency Medicine,Ospedali Riuniti Umberto I - Lancisi- Salesi,Ancona,Italy
,
Simone Vanni
Affiliations:
Emergency Medicine,Careggi University Hospital,Firenze,Italy
,
Giorgia Manina
Affiliations:
Emergency Medicine,Policlinico Maggiore,Milano,Italy
,
Sergio Cattinelli
Affiliations:
Emergency Medicine,Ospedale Cattinara,Trieste,Italy
,
Roberto Cappelli
Affiliations:
Internal Medicine,University of Siena,Siena,Italy
,
Rodolfo Sbrojavacca
Affiliations:
Emergency Medicine,Santa Maria della Misericordia Hospital,Udine,Italy
,
Fulvio Pomero
Affiliations:
Internal Medicine,Santa Croce Hospita,Cuneo,Italy
,
Sandra Marten
Affiliations:
Technische Universität Dresden,Dresden,Germany
Giancarlo Agnelli
Affiliations:
University Of Perugia,PERUGIA,Italy
(Abstract release date: 05/19/16) EHA Library. Franco L. 06/10/16; 135172; S139
Dr. Laura Franco
Dr. Laura Franco
Contributions
Abstract
Abstract: S139

Type: Oral Presentation

Presentation during EHA21: On Friday, June 10, 2016 from 12:15 - 12:30

Location: Room H4

Background
Limited data are available on major bleeding (MB) occurring during treatment with vitamin K (VKAs) or non-vitamin K antagonist oral anticoagulants (NOACs) outside clinical trials.

Aims
The aim of this study was to compare clinical presentation, management and outcome of MB in patients on treatment with VKA or NOAC in real-life.

Methods
Patients hospitalized for MB while on treatment with VKAs or NOACs were included in a multicenter study to compare clinical presentation, management and outcome of bleeding. The primary study outcome was in-hospital death.

Results
As for September 2015, 806 patients with MB were included in the study, 76% on VKAs and 24% on NOACs. MB was an intracranial hemorrhage in 51% and 21% patients on VKAs or NOACs, respectively (Odds Ratio [OR] 3.79; 95% confidence interval [CI] 2.59-5.54) a gastrointestinal bleeding in 46% and 25% patients on NOACs and VKAs, respectively (OR 2.62; 95% CI 1.87-3.68).  In-hospital death occurred in 134 patients (17%), 19% of VKA and 10% of NOAC patients (OR 2.08; 95% CI 1.24-3.49, p=0.005). The rate of in-hospital death was similar in NOAC and VKA patients with intracranial hemorrhage (27% and 26% respectively; OR 1.02, 95% CI 0.49-2.12) and gastrointestinal bleeding (7% and 11%; OR 0.62, 95% CI 0.23-1.64) and lower in NOAC than VKA patients with other MBs (3% and 11%; OR 0.39, 95% CI 0.11-0.39).

Conclusion
Among patients hospitalized for MB while on treatment with anticoagulants, patients on NOACs are less frequently admitted for intracranial hemorrhage and more frequently for gastrointestinal bleeding as compared with patients treated with VKA. Mortality is lower in patients with MBs on NOACs than VKAs although this finding varies across the different types of MBs. 

Session topic: Thrombosis

Keyword(s): Bleeding, Cerebral hemorrhage, Oral anticoagulant
Abstract: S139

Type: Oral Presentation

Presentation during EHA21: On Friday, June 10, 2016 from 12:15 - 12:30

Location: Room H4

Background
Limited data are available on major bleeding (MB) occurring during treatment with vitamin K (VKAs) or non-vitamin K antagonist oral anticoagulants (NOACs) outside clinical trials.

Aims
The aim of this study was to compare clinical presentation, management and outcome of MB in patients on treatment with VKA or NOAC in real-life.

Methods
Patients hospitalized for MB while on treatment with VKAs or NOACs were included in a multicenter study to compare clinical presentation, management and outcome of bleeding. The primary study outcome was in-hospital death.

Results
As for September 2015, 806 patients with MB were included in the study, 76% on VKAs and 24% on NOACs. MB was an intracranial hemorrhage in 51% and 21% patients on VKAs or NOACs, respectively (Odds Ratio [OR] 3.79; 95% confidence interval [CI] 2.59-5.54) a gastrointestinal bleeding in 46% and 25% patients on NOACs and VKAs, respectively (OR 2.62; 95% CI 1.87-3.68).  In-hospital death occurred in 134 patients (17%), 19% of VKA and 10% of NOAC patients (OR 2.08; 95% CI 1.24-3.49, p=0.005). The rate of in-hospital death was similar in NOAC and VKA patients with intracranial hemorrhage (27% and 26% respectively; OR 1.02, 95% CI 0.49-2.12) and gastrointestinal bleeding (7% and 11%; OR 0.62, 95% CI 0.23-1.64) and lower in NOAC than VKA patients with other MBs (3% and 11%; OR 0.39, 95% CI 0.11-0.39).

Conclusion
Among patients hospitalized for MB while on treatment with anticoagulants, patients on NOACs are less frequently admitted for intracranial hemorrhage and more frequently for gastrointestinal bleeding as compared with patients treated with VKA. Mortality is lower in patients with MBs on NOACs than VKAs although this finding varies across the different types of MBs. 

Session topic: Thrombosis

Keyword(s): Bleeding, Cerebral hemorrhage, Oral anticoagulant

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