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Journal of General Internal Medicine

, Volume 35, Issue 1, pp 371–373 | Cite as

Emergency Visits for Oral Anticoagulant Bleeding

  • Andrew I. GellerEmail author
  • Nadine Shehab
  • Maribeth C. Lovegrove
  • Kathleen O. Rose
  • Nina J. Weidle
  • Sandra K. Goring
  • Daniel S. Budnitz
Concise Research Report
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Bleeding Related to Oral Anticoagulants: US Emergency Department Visits, 2017

INTRODUCTION

Warfarin was the mainstay of outpatient antithrombotic management for decades, but in 2010, direct-acting oral anticoagulants (DOACs) were introduced with fixed dosing and without requirements for laboratory monitoring.1 Clinical trials suggested lower rates of major bleeding with DOACs than with warfarin.2, 3 The number of patients prescribed DOACs has been increasing, yet the number treated for emergent DOAC-related bleeding in the USA is unknown.4

METHODS

We estimated emergency department (ED) visits for oral anticoagulant-related bleeding using the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance (NEISS-CADES) project, an active public health surveillance system based on a nationally representative, size-stratified probability sample of US hospitals. As described previously, trained abstractors record clinician-diagnosed adverse drug events (ADEs)...

Notes

Acknowledgments

The authors thank Ms. Arati Baral and Mr. Alex Tocitu, from Northrop Grumman (contractor to CDC), for assistance with data coding and programming. The authors also thank Mr. Tom Schroeder, Ms. Elenore Sonski, and Mr. Herman Burney, and data abstractors from the US Consumer Product Safety Commission, for their assistance with data acquisition; as well as Dr. Ruth Moro, MD, MPH, for editing assistance. No individuals named herein received compensation for their contributions.

Author Contributions

Dr. Geller had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Geller, Shehab, Budnitz

Acquisition of data: all authors

Analysis and interpretation of data: all authors

Drafting of the manuscript: Geller, Shehab, Budnitz

Critical revision of the manuscript for important intellectual content: all authors

Statistical analysis: Geller

Administrative, technical, and material support: all authors

Study supervision: Geller, Shehab, Budnitz

Funding Information

The funding source was the US federal government.

Compliance with Ethical Standards

Federal government employees led or participated in all aspects of the project, including design and conduct of the project; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The findings and conclusions in this study are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

REFERENCES

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    Joppa SA, Salciccioli J, Adamski J, et al. A Practical Review of the Emerging Direct Anticoagulants, Laboratory Monitoring, and Reversal Agents. J Clin Med 2018;7(2)  https://doi.org/10.3390/jcm7020029.CrossRefGoogle Scholar
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    Alalwan AA, Voils SA, Hartzema AG. Trends in utilization of warfarin and direct oral anticoagulants in older adult patients with atrial fibrillation. Am J Health Syst Pharm 2017;74(16):1237-1244.  https://doi.org/10.2146/ajhp160756.CrossRefPubMedGoogle Scholar
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    Geller AI, Lovegrove MC, Shehab N, et al. National Estimates of Emergency Department Visits for Antibiotic Adverse Events Among Adults-United States, 2011-2015. J Gen Intern Med 2018;33(7):1060-1068.  https://doi.org/10.1007/s11606-018-4430-x.CrossRefPubMedPubMedCentralGoogle Scholar
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    Barnes GD, Nallamothu BK, Sales AE, et al. Reimagining Anticoagulation Clinics in the Era of Direct Oral Anticoagulants. Circ Cardiovasc Qual Outcomes 2016;9(2):182-5.  https://doi.org/10.1161/CIRCOUTCOMES.115.002366.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Society of General Internal Medicine (This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply) 2019

Authors and Affiliations

  • Andrew I. Geller
    • 1
    Email author
  • Nadine Shehab
    • 1
  • Maribeth C. Lovegrove
    • 1
  • Kathleen O. Rose
    • 1
    • 2
  • Nina J. Weidle
    • 1
    • 3
  • Sandra K. Goring
    • 1
    • 2
  • Daniel S. Budnitz
    • 1
  1. 1.Division of Healthcare Quality Promotion Centers for Disease Control and Prevention (CDC)AtlantaUSA
  2. 2.Northrup Grumman CorporationAtlantaUSA
  3. 3.Eagle Global Scientific LLCAtlantaUSA

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