An automated database case definition for serious bleeding related to oral anticoagulant use

Authors

  • Andrew Cunningham,

    1. Division of Clinical Pharmacology, Department of Medicine, Nashville, TN, USA
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  • C. Michael Stein,

    1. Division of Clinical Pharmacology, Department of Medicine, Nashville, TN, USA
    2. Department of Pharmacology, Nashville, TN, USA
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  • Cecilia P. Chung,

    1. Division of Clinical Pharmacology, Department of Medicine, Nashville, TN, USA
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  • James R. Daugherty,

    1. Division of Pharmacoepidemiology, Department of Preventive Medicine, Nashville, TN, USA
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  • Walter E. Smalley,

    1. Department of Gastroenterology, Nashville, TN, USA
    2. The Geriatric Research, Education and Clinical Center, Veterans Administration Tennessee Valley HealthCare System, Nashville, TN, USA
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  • Wayne A. Ray

    Corresponding author
    1. Division of Pharmacoepidemiology, Department of Preventive Medicine, Nashville, TN, USA
    2. The Geriatric Research, Education and Clinical Center, Veterans Administration Tennessee Valley HealthCare System, Nashville, TN, USA
    • Department of Preventive Medicine, Village at Vanderbilt, Suite 2600, 1501 21st Ave South, Nashville, TN 37212, USA.
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ABSTRACT

Purpose

Bleeding complications are a serious adverse effect of medications that prevent abnormal blood clotting. To facilitate epidemiologic investigations of bleeding complications, we developed and validated an automated database case definition for bleeding-related hospitalizations.

Methods

The case definition utilized information from an in-progress retrospective cohort study of warfarin-related bleeding in Tennessee Medicaid enrollees 30 years of age or older. It identified inpatient stays during the study period of January 1990 to December 2005 with diagnoses and/or procedures that indicated a current episode of bleeding. The definition was validated by medical record review for a sample of 236 hospitalizations.

Results

We reviewed 186 hospitalizations that had medical records with sufficient information for adjudication. Of these, 165 (89%, 95%CI: 83–92%) were clinically confirmed bleeding-related hospitalizations. An additional 19 hospitalizations (10%, 7–15%) were adjudicated as possibly bleeding-related. Of the 165 clinically confirmed bleeding-related hospitalizations, the automated database and clinical definitions had concordant anatomical sites (gastrointestinal, cerebral, genitourinary, other) for 163 (99%, 96–100%). For those hospitalizations with sufficient information to distinguish between upper/lower gastrointestinal bleeding, the concordance was 89% (76–96%) for upper gastrointestinal sites and 91% (77–97%) for lower gastrointestinal sites.

Conclusion

A case definition for bleeding-related hospitalizations suitable for automated databases had a positive predictive value of between 89% and 99% and could distinguish specific bleeding sites. Copyright © 2011 John Wiley & Sons, Ltd.

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