Background and Importance DOACs were developed to minimise the drawbacks of oral vitamin K antagonists (VKAs). The goal of the new drugs was to keep or improve the efficacy as well as the safety in the bleeding monitoring. Pivotal clinical trials showed a favourable benefit/risk ratio. However, these studies had methodological limitations.
Aim and Objectives To determine the frequency of bleeding events that require hospital admission in patients receiving DOAC treatment, analysing the characteristics of the patients and classifying the bleeding events according to the type of DOAC and the site of bleeding.
Material and Methods Retrospective observational study that includes all patients treated with DOACs who required hospital admission due to a bleeding event(ICD-10-CM: T45.51).The study was performed between January 2016 and March 2022. The variables collected were: sex, age, DOAC and type of haemorrhage responsible for hospital admission. Data were collected from computerised medical records and they were analysed with the statistical program SPSS®.
Results 53 hospital admissions were included. The mean age was 79.3 ± 7.1years. 37 (69.8%) episodes corresponded to men. If bleeding event was associated with the type of DOAC, it was found: 20 (37.7%) episodes for dabigatran, 17 (32.1%) for apixaban, 8 (15.1%) for rivaroxaban and 8 (15.1%) for edoxaban. Regarding type of haemorrhage, 23(43.4%) episodes were related to lower gastrointestinal bleeding (LGIB), 11 (20.8%) to haematuria, 9 (17%) to upper gastrointestinal bleeding (UGIB) and 7 (13.2%) to intracranial haemorrhage (ICH).
The most prevalent DOAC in each haemorrhage was studied. Dabigatran was the most frequent with 10 (43.5%) events in LGIB and with 5 (71.4%) cases in ICH. However, apixaban was the most frequent with 4 (44.4%)episodes in UGIB and with 4 (36.4%) cases of haematuria.
Regarding type of bleeding by sex, LGIB (OR=1.68; CI =0.74-3.83) and ICH (OR=2.19; CI =0.98-4.90) were more frequent in women, while haematuria (OR=1.41; CI =1.06-1.90) and UGIB (OR=1.35; CI = 0.99-1.85) were more common in men.
By age range, percentages of UGIB, haematuria and ICH cases were higher in patients aged 80 years or older, being 55.6%, 54.5% and 57.1% respectively. LGIB occurred in patients younger than 80 years (56,5%).
Conclusion and Relevance Patients who required hospitalisation were elderly, having a higher risk of suffering different haemorrhages when were over 80 years old. Statistically significant differences between haematuria and men were observed. Gastrointestinal haemorrhages and haematurias were the most frequent diagnosis. Dabigatran was the cause for most of the hospital admissions, being mainly involved in LGIB and ICH, followed by apixaban, related with UGIB and haematuria.
Conflict of Interest No conflict of interest.
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