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A three-year prospective study of the presentation and clinical outcomes of major bleeding episodes associated with oral anticoagulant use in the UK (ORANGE study).

Green, L; Tan, J; Morris, JK; Alikhan, R; Curry, N; Everington, T; Maclean, R; Saja, K; Stanworth, S; Tait, C; et al. Green, L; Tan, J; Morris, JK; Alikhan, R; Curry, N; Everington, T; Maclean, R; Saja, K; Stanworth, S; Tait, C; MacCallum, P (2018) A three-year prospective study of the presentation and clinical outcomes of major bleeding episodes associated with oral anticoagulant use in the UK (ORANGE study). Haematologica, 103 (4). pp. 738-745. ISSN 1592-8721 https://doi.org/10.3324/haematol.2017.182220
SGUL Authors: Morris, Joan Katherine Tan, Joachim Wei Li

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Abstract

The outcomes of patients developing major bleeding while on oral anticoagulants remain largely unquantified. The objectives of this study were to: (i) describe the burden of major hemorrhage associated with all available oral anticoagulants in terms of proportion of bleeds which are intracranial hemorrhages, in-hospital mortality and duration of hospitalization following major bleeding; (ii) identify risk factors for mortality; and (iii) compare the characteristics of major hemorrhage between cases treated with warfarin and direct oral anticoagulants for the subgroups of patients with atrial fibrillation or venous thromboembolism. This was a multicenter, 3-year prospective cohort study of patients aged ≥18 years on oral anticoagulants who developed major hemorrhage leading to hospitalization. The patients were followed up for 30 days or until discharge or death, whichever occurred first. In total 2,192 patients (47% female, 81% on warfarin, median age 80 years) were reported between October 2013 and August 2016 from 32 hospitals in the UK. Bleeding sites were intracranial (44%), gastrointestinal (33%), and other (24%). The in-hospital mortality was 21% (95% CI: 19%-23%) overall, and 33% (95% CI: 30%-36%) for patients with intracranial hemorrhage. Intracranial hemorrhage, advanced age, spontaneous bleeding, liver failure and cancer were risk factors for death. Compared to warfarin-treated patients, patients treated with direct oral anticoagulants were older and had lower odds of subdural/epidural, subarachnoid and intracerebral bleeding. The mortality rate due to major bleeding was not different between patients being treated with warfarin or direct oral anticoagulants. Major bleeding while on oral anticoagulant therapy leads to considerable hospital stays and short-term mortality.

Item Type: Article
Additional Information: ©2018 Ferrata Storti Foundation Material published in Haematologica is covered by copyright. All rights are reserved to the Ferrata Storti Foundation. Use of published material is allowed under the following terms and conditions: https://creativecommons.org/licenses/by-nc/4.0/legalcode. Copies of published material are allowed for personal or internal use. Sharing published material for non-commercial purposes is subject to the following conditions: https://creativecommons.org/licenses/by-nc/4.0/legalcode, sect. 3. Reproducing and sharing published material for commercial purposes is not allowed without permission in writing from the publisher.
Keywords: 1102 Cardiovascular Medicine And Haematology, Immunology
SGUL Research Institute / Research Centre: Academic Structure > Population Health Research Institute (INPH)
Journal or Publication Title: Haematologica
ISSN: 1592-8721
Language: eng
Dates:
DateEvent
April 2018Published
25 January 2018Published Online
22 January 2018Accepted
Publisher License: Creative Commons: Attribution-Noncommercial 4.0
Projects:
Project IDFunderFunder ID
UNSPECIFIEDBritish Society for Haematologyhttp://dx.doi.org/10.13039/501100000376
PubMed ID: 29371325
Web of Science ID: WOS:000428242100033
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/110504
Publisher's version: https://doi.org/10.3324/haematol.2017.182220

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