Journal article
Oral Anticoagulation in Patients in the Emergency Department: High Rates of Off-Label Doses, No Difference in Bleeding Rates.
- Eschler CM Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland.
- Woitok BK Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland.
- Funk GC Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Wilheminenspital, Vienna, Austria.
- Walter P Department of Laboratory Medicine, Buergerspital Solothurn, Solothurn, Switzerland.
- Maier V Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland.
- Exadaktylos AK Department of Emergency Medicine, Inselspital, University Hospital Bern, Bern, Switzerland.
- Lindner G Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland. Electronic address: gregor.lindner@spital.so.ch.
- 2019-11-01
Published in:
- The American journal of medicine. - 2020
Anticoagulation
Bleeding
Dosage
Emergency
Administration, Oral
Aged
Anticoagulants
Atrial Fibrillation
Dabigatran
Emergency Service, Hospital
Female
Hemorrhage
Humans
Male
Off-Label Use
Pyrazoles
Pyridines
Pyridones
Retrospective Studies
Rivaroxaban
Stroke
Thiazoles
Vitamin K
English
BACKGROUND
Empirically, a significant proportion of patients using direct oral anticoagulation (DOAC) take off-label reduced doses. We aimed to investigate the prevalence, indications, dosages, and bleeding complications of oral anticoagulants on admission to the emergency department.
METHODS
In this retrospective analysis, patients presenting to our emergency department between January 1 and December 31, 2018, with therapeutic oral anticoagulation were included (ie, vitamin-K antagonists, rivaroxaban, apixaban, edoxaban, and dabigatran). A detailed chart review was performed for each case concerning characteristics, indication, and bleeding complications.
RESULTS
A total of 19,662 consecutive cases in the emergency department were reported: 1721 (9%) had therapeutic oral anticoagulation. Vitamin-K antagonists (41%), rivaroxaban (36%), and apixaban (19%) were the most common. Stroke prophylaxis in patients with atrial fibrillation (63.2%) and venous thromboembolism (24.1%) were the most common indications. In 27 cases (1.6%), no indication could be identified; further, 32% of patients were classified to have either off-label doses of DOACs or an international normalized ratio (INR) out of range (in vitamin-K antagonists), whereas 20% were classified as off-label underdosed and 12% as overdosed. No difference in the likelihood of bleeding on admission could be found between the respective drugs. Only concomitant use of aspirin was significantly associated with presence and higher severity of bleeding.
CONCLUSIONS
Vitamin-K antagonists are still the most widely used drug followed by rivaroxaban. A significant proportion of patients are being prescribed off label-doses. While no difference was found for the respective anticoagulants with respect to bleeding, concomitant aspirin use was a significant predictor for bleeding in our collective.
Empirically, a significant proportion of patients using direct oral anticoagulation (DOAC) take off-label reduced doses. We aimed to investigate the prevalence, indications, dosages, and bleeding complications of oral anticoagulants on admission to the emergency department.
METHODS
In this retrospective analysis, patients presenting to our emergency department between January 1 and December 31, 2018, with therapeutic oral anticoagulation were included (ie, vitamin-K antagonists, rivaroxaban, apixaban, edoxaban, and dabigatran). A detailed chart review was performed for each case concerning characteristics, indication, and bleeding complications.
RESULTS
A total of 19,662 consecutive cases in the emergency department were reported: 1721 (9%) had therapeutic oral anticoagulation. Vitamin-K antagonists (41%), rivaroxaban (36%), and apixaban (19%) were the most common. Stroke prophylaxis in patients with atrial fibrillation (63.2%) and venous thromboembolism (24.1%) were the most common indications. In 27 cases (1.6%), no indication could be identified; further, 32% of patients were classified to have either off-label doses of DOACs or an international normalized ratio (INR) out of range (in vitamin-K antagonists), whereas 20% were classified as off-label underdosed and 12% as overdosed. No difference in the likelihood of bleeding on admission could be found between the respective drugs. Only concomitant use of aspirin was significantly associated with presence and higher severity of bleeding.
CONCLUSIONS
Vitamin-K antagonists are still the most widely used drug followed by rivaroxaban. A significant proportion of patients are being prescribed off label-doses. While no difference was found for the respective anticoagulants with respect to bleeding, concomitant aspirin use was a significant predictor for bleeding in our collective.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.amjmed.2019.09.026
- PMID 31668901
- Persistent URL
- https://sonar.ch/global/documents/185354
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