Antithrombotic Medication Use and Bleeding Risk in Medically Ill Patients After Hospitalization. (September 2013)

• Record Type: Journal Article
• Authors: Mahan, Charles E.; Spyropoulos, Alex C.; Fisher, Maxine D.; Fields, Larry E.; Mills, Roger M.; Stephenson, Judith J.; Fu, An-Chen; Klaskala, Winslow
• Is Part Of: Clinical and applied thrombosis/hemostasis. Volume 19:Number 5(2013)
• Page Start: 504
• Page End: 512
• Publication Date: 2013-09
• Subjects: bleeding -- venous thromboembolism -- thrombosis prophylaxis -- antiplatelet -- drugs -- anticoagulants; Hemostasis -- Periodicals; Thrombosis -- Periodicals; 616.13
• DOI: 10.1177/1076029612470967
• Languages: English
• ISSNs: 1076-0296

Abstract

Background: Hospitalized medically ill patients receiving antithrombotic medications experience increased risk of bleeding. We examined antithrombotic use, bleeding rates, and associated risk factors at 30 days post discharge. Methods: This retrospective database analysis included nonsurgical patients aged ≥40 years hospitalized for ≥2 days during 2005 to 2009. Previously cited, validated International Classification of Diseases, Ninth Revision, Clinical Modification codes for major bleeding were used to define clinically relevant bleeding. Results: Of the 327, 578 patients, 9.1% received antithrombotic medications, of which 3.7% were anticoagulants. Rates of major and minor bleeding were 1.8% and 7.1%, respectively. Preindex gastroduodenal ulcer, thromboembolic stroke, blood dyscrasias, liver disease, and rehospitalization were the strongest predictors of major bleeding. Other risk factors included increasing age, male gender, and hospital stay of ≥3 days. Conclusions: Careful consideration of these demonstrated bleed-associated comorbidities before initiating anticoagulation or combining antithrombotic medications in medically ill patients may improve strategies for prevention of postdischarge thromboembolism.