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Conference Paper: Gastrointestinal haemorrhage in atrial fibrillation patients: impact of quality of anticoagulation control

TitleGastrointestinal haemorrhage in atrial fibrillation patients: impact of quality of anticoagulation control
Authors
Issue Date2016
PublisherHong Kong Academy of Medicine Press. The Journal's web site is located at http://www.hkmj.org/
Citation
The 21st Medical Research Conference (MRC 2016), Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, 16 June 2016. In Hong Kong Medical Journal, 2016, v. 22 suppl. 1, p. 11, abstract no. 4 How to Cite?
AbstractBACKGROUND: Gastrointestinal haemorrhage is a known complication of antiplatelet and anticoagulation therapy. Little is known about the impact of warfarin of different time in therapeutic range (TTR) on the risk of gastrointestinal haemorrhage in atrial fibrillation (AF) patients compared to aspirin. METHODS: This was an observational study. RESULTS: We studied 5426 Chinese AF patients (77.7 ± 10.7 years; female: 53.1%) with CHA2DS2-VASc score of ≥1—3832 (70.6%) patients were taking aspirin, 1594 (29.4%) patients were taking warfarin, while the remaining patients did not receive any anticoagulation. The mean baseline HAS-BLED score (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly) was 2.22 ± 0.93. Among those on warfarin, the median TTR was 39.2%. After a mean follow-up of 3.6 years (19 777 patient-years), 262 (4.83%) patients developed gastrointestinal haemorrhage requiring transfusion with an annual incidence of 1.32%. Annual incidences of gastrointestinal haemorrhage requiring transfusion among patients on aspirin and warfarin were 1.53% and 1.00%, respectively. For patients on warfarin, the incidence of gastrointestinal haemorrhage increased progressively with higher HAS-BLED scores, from 0.93% per year for those with HAS-BLED score of ≤1 to 1.68% per year for those with HAS-BLED score of ≥3, and decreased progressively with increasing TTR from 1.69% per year for patients in the lowest quartile of TTR to only 0.51% per year for those in the top quartile. CONCLUSION: Overall, aspirin was associated with a higher risk of gastrointestinal bleeding compared with warfarin despite the suboptimal TTR in the study population. For patients on warfarin, HAS-BLED score at baseline prior to commencing anticoagulation positively correlated with gastrointestinal bleeding. Poor TTR was associated with a higher risk of gastrointestinal bleeding
Persistent Identifierhttp://hdl.handle.net/10722/232492
ISSN
2015 Impact Factor: 0.887
2015 SCImago Journal Rankings: 0.279

 

DC FieldValueLanguage
dc.contributor.authorChan, PHM-
dc.contributor.authorLi, WHS-
dc.contributor.authorHai, SHJJ-
dc.contributor.authorChan, KH-
dc.contributor.authorTse, HF-
dc.contributor.authorCheung, BMY-
dc.contributor.authorLeung, WK-
dc.contributor.authorHung, FNI-
dc.contributor.authorSiu, DCW-
dc.date.accessioned2016-09-20T05:30:23Z-
dc.date.available2016-09-20T05:30:23Z-
dc.date.issued2016-
dc.identifier.citationThe 21st Medical Research Conference (MRC 2016), Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, 16 June 2016. In Hong Kong Medical Journal, 2016, v. 22 suppl. 1, p. 11, abstract no. 4-
dc.identifier.issn1024-2708-
dc.identifier.urihttp://hdl.handle.net/10722/232492-
dc.description.abstractBACKGROUND: Gastrointestinal haemorrhage is a known complication of antiplatelet and anticoagulation therapy. Little is known about the impact of warfarin of different time in therapeutic range (TTR) on the risk of gastrointestinal haemorrhage in atrial fibrillation (AF) patients compared to aspirin. METHODS: This was an observational study. RESULTS: We studied 5426 Chinese AF patients (77.7 ± 10.7 years; female: 53.1%) with CHA2DS2-VASc score of ≥1—3832 (70.6%) patients were taking aspirin, 1594 (29.4%) patients were taking warfarin, while the remaining patients did not receive any anticoagulation. The mean baseline HAS-BLED score (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly) was 2.22 ± 0.93. Among those on warfarin, the median TTR was 39.2%. After a mean follow-up of 3.6 years (19 777 patient-years), 262 (4.83%) patients developed gastrointestinal haemorrhage requiring transfusion with an annual incidence of 1.32%. Annual incidences of gastrointestinal haemorrhage requiring transfusion among patients on aspirin and warfarin were 1.53% and 1.00%, respectively. For patients on warfarin, the incidence of gastrointestinal haemorrhage increased progressively with higher HAS-BLED scores, from 0.93% per year for those with HAS-BLED score of ≤1 to 1.68% per year for those with HAS-BLED score of ≥3, and decreased progressively with increasing TTR from 1.69% per year for patients in the lowest quartile of TTR to only 0.51% per year for those in the top quartile. CONCLUSION: Overall, aspirin was associated with a higher risk of gastrointestinal bleeding compared with warfarin despite the suboptimal TTR in the study population. For patients on warfarin, HAS-BLED score at baseline prior to commencing anticoagulation positively correlated with gastrointestinal bleeding. Poor TTR was associated with a higher risk of gastrointestinal bleeding-
dc.languageeng-
dc.publisherHong Kong Academy of Medicine Press. The Journal's web site is located at http://www.hkmj.org/-
dc.relation.ispartofHong Kong Medical Journal-
dc.rightsHong Kong Medical Journal. Copyright © Hong Kong Academy of Medicine Press.-
dc.titleGastrointestinal haemorrhage in atrial fibrillation patients: impact of quality of anticoagulation control-
dc.typeConference_Paper-
dc.identifier.emailChan, PHM: phmchan@hku.hk-
dc.identifier.emailHai, SHJJ: haishjj@hku.hk-
dc.identifier.emailChan, KH: drkhchan@hku.hk-
dc.identifier.emailTse, HF: hftse@hkucc.hku.hk-
dc.identifier.emailCheung, BMY: mycheung@hkucc.hku.hk-
dc.identifier.emailLeung, WK: waikleung@hku.hk-
dc.identifier.emailHung, FNI: ivanhung@hkucc.hku.hk-
dc.identifier.emailSiu, DCW: cwdsiu@hkucc.hku.hk-
dc.identifier.authorityChan, PHM=rp01864-
dc.identifier.authorityHai, SHJJ=rp02047-
dc.identifier.authorityTse, HF=rp00428-
dc.identifier.authorityCheung, BMY=rp01321-
dc.identifier.authorityLeung, WK=rp01479-
dc.identifier.authorityHung, FNI=rp00508-
dc.identifier.authoritySiu, DCW=rp00534-
dc.identifier.hkuros266205-
dc.identifier.volume22-
dc.identifier.issuesuppl. 1-
dc.identifier.spage11, abstract no. 4-
dc.identifier.epage11, abstract no. 4-
dc.publisher.placeHong Kong-

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