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Diabetes mellitus is associated with increased bleeding in pulmonary embolism receiving conventional anticoagulant therapy: findings from a “real-world” study

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Abstract

Bleeding refers to the most important complication during anticoagulation therapy in patients with pulmonary embolism (PE). However, the incidence and risk factors of bleeding in Chinese population with anticoagulant therapy remains unknown. Although diabetes mellitus (DM) has been demonstrated to increase the risk of PE, little information of its influence on anticoagulation-associated bleeding risk can be available. In our study, 563 acute PE patients, who fulfilled the including criteria were enrolled from a single center and received conventional anticoagulant therapy. And there were 539 patients completed the 3 months following-up. The cumulative incidences of major bleeding (MB) and clinically relevant non-major bleeding (CRNMB) were 3.0% (95% CI 1.01–3.05) and 14.0% (95% CI 1.47–5.21), respectively. Besides, anemia (OR 3.52, 95% CI 1.12–11.41) and recent history of MB (OR 8.14, 95% CI 1.41–31.95) were independently associated with MB. Age >65 year (OR 1.51, 95% CI 1.12–3.11), cancer (OR 2.01, 95% CI 1.12–4.01) and therapeutic range (TTR) during 3 months (OR 0.93, 95% CI 0.91–0.98) were independently associated with CRNMB. Additionally, DM was an independent risk factor for both MB (OR 2.11, 95% CI 1.10–4.12) and CRNMB (OR 2.11, 95% CI 1.10–4.12). Notably, the incidence of MB or CRNMB was significantly higher in DM patients than non-DM patients. At the end of 3-month follow-up, the HbA1C in CRNMB group was 8.3%, yet it was 7.0% in non-CRNMB group among diabetic patients (p = 0.04). In conclusions, the bleeding rates are high in patients with acute PE who receive anticoagulant therapy. In addition to the already known bleeding risk factors, DM can also increase the bleeding risk significantly. Thus, good glycemic control may be essential after prescription of anticoagulant therapy.

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Abbreviations

PE:

Pulmonary embolism

DM:

Diabetes mellitus

CI:

Confidence interval

OR:

Odds ratio

PA:

Pulmonary arteriography

CTPA:

Computed tomographic pulmonary angiography

V/Q:

Ventilation perfusion

MRPA:

Magnetic resonance pulmonary angiography

LWMH:

Low molecular weight heparin

INR:

International normalized ratio

TTR:

Time in therapeutic range

VKA:

Vitamin K Antagonist

MB:

Major bleeding

CRNMB:

Clinically relevant non-major bleeding

RCT:

Randomized controlled trials

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Funding

This study was supported by the Fund of The National Key Research and Development Program of China (No. 2016YFC0905600), China Key Research Projects of the 11th National Five-year Development Plan (No. 2006BAI01A06), Beijing Youth Star of Science and Technology Program (No. 2007B037); The capital health research and development of special fund (2011-1004-03); National Department of Public Benefit Research Foundation by Ministry of Health P. R. China (No. 201,302,008), Beijing Natural Science Foundation (7,152,062); National Natural Science Foundation of China (No. 81,570,049).

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Authors and Affiliations

  1. Center for Cardiac Intensive Care, Beijing An-Zhen hospital, Capital Medical University, Beijing, People’s Republic of China

    Zhu Zhang

  2. Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China

    Zhu Zhang, Zhenguo Zhai, Yuanhua Yang, Jun Wan, Wanmu Xie & Chen Wang

  3. Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Capital Medical University, Yinghua Dongjie, Beijing, 100029, People’s Republic of China

    Zhenguo Zhai, Jun Wan, Wanmu Xie & Chen Wang

  4. Department of Respiratory Medicine, Capital Medical University, Beijing, People’s Republic of China

    Zhenguo Zhai, Yuanhua Yang, Jun Wan, Wanmu Xie & Chen Wang

  5. National Clinical Research Center of Respiratory Medicine, Beijing, People’s Republic of China

    Jianguo Zhu & Chen Wang

  6. Department of Cardiothoracic Surgery, Baylor College of Medicine, Houston, USA

    Ying H. Shen

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  1. Zhu Zhang
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  2. Zhenguo Zhai
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  3. Yuanhua Yang
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Corresponding author

Correspondence to Zhenguo Zhai.

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Appendix

Appendix

See Table 5.

Table 5 Comparison of bleeding events in patients with DM at the end of 3 months follow-up
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Zhang, Z., Zhai, Z., Yang, Y. et al. Diabetes mellitus is associated with increased bleeding in pulmonary embolism receiving conventional anticoagulant therapy: findings from a “real-world” study. J Thromb Thrombolysis 43, 540–549 (2017). https://doi.org/10.1007/s11239-017-1473-5

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