Contributions
Abstract: P12
Type: Poster presentation
Presentation during EHA Scientific Conference on Bleeding Disorders:
On Friday, September 16, 2016 from 14:00 - 15:30
Location: Cristal + Coral
Background
Anticoagulation therapy is the mainstay of treatment for many health conditions. This includes venous thromboembolic disease, atrial fibrillation and thromboembolism secondary to metallic heart valve replacement. Whilst anticoagulant therapy has been proven effective in such conditions, they do carry significant morbidity and mortality, particularly in the form of acquired bleeding tendencies.
Historically, the mainstay of treatments has been with courmarins and unfractionated heparin. This changed following the introduction of low molecular weight heparin (LMWH), and subsequently with the development of direct oral anticoagulant medications (DOAC). Much evidence has been produced analysing the effectiveness of DOAC medications, and also their associated risks of bleeding. It remains important to note that experience of DOACs (and their novel reversal agents) is still limited, and many clinicians’ experience is still lacking.
Previous audits within our institution have shown LMWH to be associated with significant bleeding squeal when associated with renal impairment.
Aims
We wanted to determine the local rate of bleeding on different anticoagulation therapies and their management and outcomes. Particular focus would be on had the rate of bleeding on patients treated with LMWH with renal impairment.
Methods
We conducted a retrospective audit of 14 patients, presenting with acute bleeding whilst on anticoagulation therapy, over a 6-month period. We collected data from our referral list, medical notes, electronic records and our transfusion laboratory. Anticoagulant therapies reviewed included warfarin, LMWH, antiplatelet agents and DOACs. We collected data on the bleeding site, reversal agents or blood products usage, renal function and finally mortality data.
Results
We present data on which bleeding sites were associated with different anticoagulant therapy, and which therapies were used in control of bleeding. We demonstrate a bleeding propensity for patients on anticoagulation therapy with impaired renal function, and also a high incidence of death. We also report a reduction in bleeding with LMWH following local changes in practice. The highest incidence of bleeding was observed in patients treated with warfarin.
Conclusion
Our local audit supports recent trial literature that patients treated with warfarin have a higher incidence of bleeding compared to novel agents. The significant reduction in bleeding on LMWH is likely secondary to staff education and training, in addition to implementation of new local protocols.
References
1. Stubbs, M.J.; Chowdhury, F.
2. Shoeb et al, Journal Thrombosis and Thrombolysis, 2013; 35;3
3. Crowther et al, Blood, 2008, 111, 10
4. Palareti et al, Thrombosis and Haemostasis, 2009, 2: 102
5. Peacock et al, Emergency Medicine International, 2016 (epub)
6. Nisio et al, Lancet, 2016, (epub)
Abstract: P12
Type: Poster presentation
Presentation during EHA Scientific Conference on Bleeding Disorders:
On Friday, September 16, 2016 from 14:00 - 15:30
Location: Cristal + Coral
Background
Anticoagulation therapy is the mainstay of treatment for many health conditions. This includes venous thromboembolic disease, atrial fibrillation and thromboembolism secondary to metallic heart valve replacement. Whilst anticoagulant therapy has been proven effective in such conditions, they do carry significant morbidity and mortality, particularly in the form of acquired bleeding tendencies.
Historically, the mainstay of treatments has been with courmarins and unfractionated heparin. This changed following the introduction of low molecular weight heparin (LMWH), and subsequently with the development of direct oral anticoagulant medications (DOAC). Much evidence has been produced analysing the effectiveness of DOAC medications, and also their associated risks of bleeding. It remains important to note that experience of DOACs (and their novel reversal agents) is still limited, and many clinicians’ experience is still lacking.
Previous audits within our institution have shown LMWH to be associated with significant bleeding squeal when associated with renal impairment.
Aims
We wanted to determine the local rate of bleeding on different anticoagulation therapies and their management and outcomes. Particular focus would be on had the rate of bleeding on patients treated with LMWH with renal impairment.
Methods
We conducted a retrospective audit of 14 patients, presenting with acute bleeding whilst on anticoagulation therapy, over a 6-month period. We collected data from our referral list, medical notes, electronic records and our transfusion laboratory. Anticoagulant therapies reviewed included warfarin, LMWH, antiplatelet agents and DOACs. We collected data on the bleeding site, reversal agents or blood products usage, renal function and finally mortality data.
Results
We present data on which bleeding sites were associated with different anticoagulant therapy, and which therapies were used in control of bleeding. We demonstrate a bleeding propensity for patients on anticoagulation therapy with impaired renal function, and also a high incidence of death. We also report a reduction in bleeding with LMWH following local changes in practice. The highest incidence of bleeding was observed in patients treated with warfarin.
Conclusion
Our local audit supports recent trial literature that patients treated with warfarin have a higher incidence of bleeding compared to novel agents. The significant reduction in bleeding on LMWH is likely secondary to staff education and training, in addition to implementation of new local protocols.
References
1. Stubbs, M.J.; Chowdhury, F.
2. Shoeb et al, Journal Thrombosis and Thrombolysis, 2013; 35;3
3. Crowther et al, Blood, 2008, 111, 10
4. Palareti et al, Thrombosis and Haemostasis, 2009, 2: 102
5. Peacock et al, Emergency Medicine International, 2016 (epub)
6. Nisio et al, Lancet, 2016, (epub)