Intern Med J. 2020 Nov 16. doi: 10.1111/imj.15136. Online ahead of print.
BACKGROUND: The predictors of clinically significant bleeding events (CSBEs) associated with direct oral anticoagulants (DOACs) are poorly characterised in literature.
AIM: To determine the incidence and predictors of CSBEs in patients receiving DOACs.
METHODS: Patients who received DOACs during admission under a general medical unit over a two-year period were retrospectively studied. Following index admission, patients were followed for 12 months or for the duration of treatment (if the latter was less than 12 months). The relevant data were obtained by review of medical records.
RESULTS: A total of 203 patients were studied over a mean follow-up period of 293 (±81) days. The incidence of CSBE was 13.7 (95%CI 9.5-21.1) per 100 person-years. Age ≥ 75 years (P=0.01), concurrent use of antiplatelet medications (P=0.02) and lower estimated creatinine clearance (CrCl) (P=0.03) had a significant univariate association with CSBEs. However, in the multivariate logistic regression only concurrent use of antiplatelet medications remained significantly associated with CSBEs (adjusted OR3.6, 95%CI:1.4-9.6, P=0.01). Concurrent use of antiplatelet medications was also independently associated with major bleeding events (MBEs) (adjusted OR4.9, 95%CI:1.1-21.4, P=0.04). Although 39 (19.2%) patients received antiplatelet medications, the indications for concurrent antiplatelet use complied with current guidelines in only 3 (7.7%) patients.
CONCLUSION: Caution should be exercised when prescribing antiplatelet medications with DOACs, as this combination is a potential risk factor for both major and non-major clinically significant bleeding events. In most patients, the concurrent use of antiplatelet medications was discordant with the current consensus guidelines. This article is protected by copyright. All rights reserved.