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Comparison of vitamin K and non-vitamin K oral anticoagulants and the bleeding frequency in the emergency department

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Abstract

Introduction

Safety studies of anticoagulant therapy have so far been conducted on many subjects in controlled conditions (i.e., clinically monitored) and demonstrated the noninferiority of new ones over old anticoagulant drugs. Data on the propositions for the presence of symptoms and signs of bleeding among various anticoagulants in the emergency department indicate that these data do not match the data published so far.

Aim

The aim of the study was to investigate the differences in the frequency of bleeding and bleeding-related symptoms as a reason for emergency department attendance in patients on anticoagulant therapy.

Methods

The study included patients from the emergency department of University Hospital for one year, who were on anticoagulant therapy and who met the inclusion criteria. Out of a total of 595 patients, 409 were on warfarin (68.74%), and the rest were taking direct oral anticoagulants (DOAC): dabigatran 71 (11.93%), rivaroxaban 66 (11.09%) and apixaban 49 (8.23%).

Results

Out of 409 patients taking warfarin, 34.4% were adequately anticoagulated with the frequency of bleeding 13.7%, while in 57.2% of patients, PT INR was higher than the reference values with the frequency of bleeding 15.0%. A comparison between all DOAC groups and adequately anticoagulated warfarin patients in the frequency of bleeding and bleeding-related symptoms as a reason for emergency attendance yielded a difference that was marginally statistically significant (Pearson Chi-Square = 7.554, p = 0.052).

Conclusion

Monitoring the frequency of bleeding and bleeding-related symptoms in patients on oral anticoagulant therapy as a reason for emergency department attendance may be a new safety and efficacy factor in real-life patient scenarios.

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Data availability statement

The data presented in this study are available on a specific request from the corresponding author.

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Funding

This research received no external funding.

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Authors and Affiliations

  1. Department of Cardiovascular Diseases, University Hospital Dubrava, 10000, Zagreb, Croatia

    Tomo Svaguša, Ognjen Čančarević, Danijela Grizelj & Aleksandar Blivajs

  2. Department of Diabetes, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Dugi dol 4a, 10000, Zagreb, Croatia

    Stjepan Šimić & Tomislav Bulum

  3. School of Medicine, University of Zagreb, Dugi dol 4a, Zagreb, Croatia

    Filip Grabant, Tatjana Kereš, Frane Paić, Tomislav Bulum & Ingrid Prkačin

  4. Department of Intensive Care Medicine, University Hospital Dubrava, Zagreb, Croatia

    Tatjana Kereš

  5. Department of Internal Medicine, University Hospital Merkur, Zagreb, Croatia

    Ingrid Prkačin

Authors
  1. Tomo Svaguša
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  9. Tomislav Bulum
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Contributions

Conceptualization, TS, FG, DG, and SŠ; data curation, TS, and IP, formal analysis, TS, TK, OČ, methodology, TS, TK, and IP; project administration, TB and IP; resources, TB, supervision, TS, and IP; writing—original draft, TS, SŠ, and IP; writing—review and editing, TS, TK, OČ, TB, and IP. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Tomislav Bulum.

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Institutional review board statement

The study was conducted following the Declaration of Helsinki and approved by the Hospital's Ethics Committee.

Informed consent

All patients included in the study received both written and oral information about the study and signed written informed consent.

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Svaguša, T., Šimić, S., Grabant, F. et al. Comparison of vitamin K and non-vitamin K oral anticoagulants and the bleeding frequency in the emergency department. High Blood Press Cardiovasc Prev 31, 23–30 (2024). https://doi.org/10.1007/s40292-023-00616-y

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