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Article: Bleeding‐related hospital admissions and 30‐day readmissions in patients with non‐valvular atrial fibrillation treated with dabigatran versus warfarin

TitleBleeding‐related hospital admissions and 30‐day readmissions in patients with non‐valvular atrial fibrillation treated with dabigatran versus warfarin
Authors
KeywordsAnticoagulant
Atrial fibrillation
Bleeding
Dabigatran
Readmission
Warfarin
Issue Date2017
PublisherWiley-Blackwell Publishing Ltd.. The Journal's web site is located at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1538-7836
Citation
Journal of Thrombosis and Haemostasis, 2017, v. 15 n. 10, p. 1923-1933 How to Cite?
AbstractBackground: Reducing 30‐day hospital readmission is a policy priority worldwide. Warfarin‐related bleeding is among the most common cause of hospital admissions as a result of adverse drug events. Compared with warfarin, dabigatran achieves a full anticoagulation effect more quickly following its initiation; hence it may lead to early‐onset bleeds. Objectives: To compare the incidence of bleeding‐related hospital admissions and 30‐day readmissions with dabigatran vs. warfarin in patients with non‐valvular atrial fibrillation (NVAF). Methods: This was a retrospective cohort study using a population‐wide database managed by the Hong Kong Hospital Authority. Patients newly diagnosed with NVAF from 2010 through to 2014 and prescribed dabigatran or warfarin were 1:1 matched by propensity score. The incidence rate of hospital admission with bleeding (a composite of gastrointestinal bleeding, intracranial hemorrhage and bleeding at other sites) was assessed. Results: Among the 51 946 patients with NVAF, 8309 users of dabigatran or warfarin were identified, with 5160 patients matched by propensity score. The incidence of first hospitalized bleeding did not differ significantly between groups (incidence rate ratio, 0.92; 95% confidence interval [CI], 0.66–1.28). Among patients who were continuously prescribed their initial anticoagulants upon discharge, dabigatran use was associated with a higher risk of 30‐day readmission with bleeding over warfarin (adjusted hazard ratio, 2.87; 95%CI, 1.10–7.43). Conclusion: When compared with warfarin, dabigatran was associated with a comparable incidence of first hospital admission but a higher risk of 30‐day redmission with respect to bleeding. Close early monitoring of patients initiated on dabigatran following hospital discharge for bleeding is warranted.
Persistent Identifierhttp://hdl.handle.net/10722/243180
ISSN
2017 Impact Factor: 4.899
2015 SCImago Journal Rankings: 2.322
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorLau, CY-
dc.contributor.authorLi, X-
dc.contributor.authorWong, ICK-
dc.contributor.authorMan, KCK-
dc.contributor.authorLip, GYH-
dc.contributor.authorLeung, WK-
dc.contributor.authorSiu, DCW-
dc.contributor.authorChan, EW-
dc.date.accessioned2017-08-25T02:51:13Z-
dc.date.available2017-08-25T02:51:13Z-
dc.date.issued2017-
dc.identifier.citationJournal of Thrombosis and Haemostasis, 2017, v. 15 n. 10, p. 1923-1933-
dc.identifier.issn1538-7933-
dc.identifier.urihttp://hdl.handle.net/10722/243180-
dc.description.abstractBackground: Reducing 30‐day hospital readmission is a policy priority worldwide. Warfarin‐related bleeding is among the most common cause of hospital admissions as a result of adverse drug events. Compared with warfarin, dabigatran achieves a full anticoagulation effect more quickly following its initiation; hence it may lead to early‐onset bleeds. Objectives: To compare the incidence of bleeding‐related hospital admissions and 30‐day readmissions with dabigatran vs. warfarin in patients with non‐valvular atrial fibrillation (NVAF). Methods: This was a retrospective cohort study using a population‐wide database managed by the Hong Kong Hospital Authority. Patients newly diagnosed with NVAF from 2010 through to 2014 and prescribed dabigatran or warfarin were 1:1 matched by propensity score. The incidence rate of hospital admission with bleeding (a composite of gastrointestinal bleeding, intracranial hemorrhage and bleeding at other sites) was assessed. Results: Among the 51 946 patients with NVAF, 8309 users of dabigatran or warfarin were identified, with 5160 patients matched by propensity score. The incidence of first hospitalized bleeding did not differ significantly between groups (incidence rate ratio, 0.92; 95% confidence interval [CI], 0.66–1.28). Among patients who were continuously prescribed their initial anticoagulants upon discharge, dabigatran use was associated with a higher risk of 30‐day readmission with bleeding over warfarin (adjusted hazard ratio, 2.87; 95%CI, 1.10–7.43). Conclusion: When compared with warfarin, dabigatran was associated with a comparable incidence of first hospital admission but a higher risk of 30‐day redmission with respect to bleeding. Close early monitoring of patients initiated on dabigatran following hospital discharge for bleeding is warranted.-
dc.languageeng-
dc.publisherWiley-Blackwell Publishing Ltd.. The Journal's web site is located at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1538-7836-
dc.relation.ispartofJournal of Thrombosis and Haemostasis-
dc.subjectAnticoagulant-
dc.subjectAtrial fibrillation-
dc.subjectBleeding-
dc.subjectDabigatran-
dc.subjectReadmission-
dc.subjectWarfarin-
dc.titleBleeding‐related hospital admissions and 30‐day readmissions in patients with non‐valvular atrial fibrillation treated with dabigatran versus warfarin-
dc.typeArticle-
dc.identifier.emailLi, X: sxueli@hku.hk-
dc.identifier.emailWong, ICK: wongick@hku.hk-
dc.identifier.emailMan, KCK: mkckth@hku.hk-
dc.identifier.emailLeung, WK: waikleung@hku.hk-
dc.identifier.emailSiu, DCW: cwdsiu@hkucc.hku.hk-
dc.identifier.emailChan, EW: ewchan@hku.hk-
dc.identifier.authorityLi, X=rp02531-
dc.identifier.authorityWong, ICK=rp01480-
dc.identifier.authorityLeung, WK=rp01479-
dc.identifier.authoritySiu, DCW=rp00534-
dc.identifier.authorityChan, EW=rp01587-
dc.description.naturelink_to_OA_fulltext-
dc.identifier.doi10.1111/jth.13780-
dc.identifier.pmid28748652-
dc.identifier.scopuseid_2-s2.0-85030469082-
dc.identifier.hkuros275449-
dc.identifier.volume15-
dc.identifier.issue10-
dc.identifier.spage1923-
dc.identifier.epage1933-
dc.identifier.isiWOS:000412464700006-
dc.publisher.placeUnited Kingdom-

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