| アブストラクト | Background There is little evidence on how the occurrence of a bleed in individuals on vitamin K antagonists (VKAs) impacts the risk of subsequent bleeds, and thromboembolic and ischemic events. Such information would help to inform treatment decisions following bleeds. Objective To estimate the impact of bleeding events on the risk of subsequent bleeds, venous thromboembolism (VTE), stroke, and myocardial infarction (MI) among patients initiating VKA treatment for new-onset nonvalvular atrial fibrillation (NVAF). Methods We conducted an observational cohort study using a linked Clinical Practice Research Datalink-Hospital Episode Statistics dataset. Among a cohort of individuals with NVAF, the risk of clinically relevant bleeding, VTE, stroke, and MI was compared between the period prior to the first bleed and the periods following each subsequent bleed. The rate and cost of general practitioner (GP) consultations, prescriptions, and hospitalizations were also compared across these periods. Results The risk of clinically relevant bleeding events was observed to be elevated at least twofold in all periods following the first bleeding event. The risk of VTE, stroke, and MI was not found to differ according to the number of clinically relevant bleeding events. The rate and cost of GP consultations, GP prescriptions, and hospitalizations were increased in all periods relative to the period prior to the first bleed. Conclusions The doubling in the risk of bleeding following the first bleed, taken alongside the stable risk of MI, VTE, and stroke, suggests that the risk-benefit balance for VKA treatment should be reconsidered following the first clinically relevant bleed. |
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| ジャーナル名 | TH open : companion journal to thrombosis and haemostasis |
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| Pubmed追加日 | 2019/10/9 |
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| 投稿者 | Alikhan, Raza; Lefevre, Cinira; Menown, Ian; Lister, Steven; Bird, Alex; You, Min; Evans, David; Sammon, Cormac |
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| 組織名 | Haemophilia and Thrombosis Centre, University Hospital of Wales, Cardiff, United;Kingdom.;Center of Observational Research and Data Sciences, Bristol-Myers Squibb,;Rueil-Malmaison, France.;Craigavon Cardiac Centre, Craigavon, United Kingdom.;UK Health Economics and Outcomes Research, Bristol-Myers Squibb, Uxbridge, United;Health Economics and Outcomes Research, Pfizer, Surrey, United Kingdom.;Plainsboro, New Jersey, United States.;PHMR Ltd., London, United Kingdom. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/31592518/ |
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