Bleeding-related hospital admissions and 30-day readmissions in patients with non-valvular atrial fibrillation treated with dabigatran versus warfarin

Authors

  • W. C. Y. Lau,

    1. Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
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  • X. Li,

    1. Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
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  • I. C. K. Wong,

    1. Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
    2. Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
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  • K. K. C. Man,

    1. Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
    2. Department of Pediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
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  • G. Y. H. Lip,

    1. Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
    2. Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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  • W. K. Leung,

    1. Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
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  • C. W. Siu,

    1. Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
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  • E. W. Chan

    Corresponding author
    1. Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
    • Correspondence: Esther W. Chan, Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Faculty of Medicine Building, L02-08, 2/F, Laboratory Block, Hong Kong

      Tel.: +852 2831 5110

      E-mail: ewchan@hku.hk

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  • Manuscript handled by: F. R. Rosendaal
  • Final decision: F. R. Rosendaal, 14 July 2017

Abstract

Essentials

  • Bleeding is a common cause of hospital admission and readmission in oral anticoagulant users.
  • Patients with dabigatran and warfarin were included to assess hospital admission risk.
  • Dabigatran users had a higher risk of 30-day readmission with bleeding than warfarin users.
  • Close monitoring following hospital discharge for dabigatran-related bleeding is warranted.

Summary

Background

Reducing 30-day hospital readmission is a policy priority worldwide. Warfarin-related bleeding is among the most common cause of hospital admissions as a result of adverse drug events. Compared with warfarin, dabigatran achieves a full anticoagulation effect more quickly following its initiation; hence it may lead to early-onset bleeds.

Objectives

To compare the incidence of bleeding-related hospital admissions and 30-day readmissions with dabigatran vs. warfarin in patients with non-valvular atrial fibrillation (NVAF).

Methods

This was a retrospective cohort study using a population-wide database managed by the Hong Kong Hospital Authority. Patients newly diagnosed with NVAF from 2010 through to 2014 and prescribed dabigatran or warfarin were 1:1 matched by propensity score. The incidence rate of hospital admission with bleeding (a composite of gastrointestinal bleeding, intracranial hemorrhage and bleeding at other sites) was assessed.

Results

Among the 51 946 patients with NVAF, 8309 users of dabigatran or warfarin were identified, with 5160 patients matched by propensity score. The incidence of first hospitalized bleeding did not differ significantly between groups (incidence rate ratio, 0.92; 95% confidence interval [CI], 0.66–1.28). Among patients who were continuously prescribed their initial anticoagulants upon discharge, dabigatran use was associated with a higher risk of 30-day readmission with bleeding over warfarin (adjusted hazard ratio, 2.87; 95%CI, 1.10–7.43).

Conclusion

When compared with warfarin, dabigatran was associated with a comparable incidence of first hospital admission but a higher risk of 30-day redmission with respect to bleeding. Close early monitoring of patients initiated on dabigatran following hospital discharge for bleeding is warranted.

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