anticoagulants, vitamin K antagonists, bleeding risk, elder patients
DISEASE INTERVENTION COMPARISON RESULTS
Arch Intern Med. 2004 Oct 11;164(18):2044-50 Cohorts
IN anticoagulants, vitamin K antagonists, bleeding risk, elder patients The Use of
insufficient therapeutic education, polypharmacy, and INR above therapeutic range
As Etiologic risk factor
Is useful Than
no comparison done
To predict increase risk of bleeding: insufficient education ([OR, 8.83), polypharmacy (OR, 6.14), and INR above range (OR 1.08). Low rate of major bleeding despite frequent comobidities and cognitive impairment: 2.4 events per 1000 patient-months
J Thromb Haemost. 2016 Sep;14(9):1715-24 Cohorts
IN anticoagulants, vitamin K antagonists, bleeding risk, elder patients The Use of
Any of 3 most commonly employed scores: HAS-BLED, ATRIA and HEMORR2 HAGES
As Prognostic Item
Is bad Than
no comparison here
To predict major bleeding: All three scores were associated with major bleeding in the elderly, but had poor predictive abilities: C-statistics < 0.60 all. Only 2 (anemia and antiplatelet therapy) of the classical risk factors were associated with bleeding
J Am Coll Cardiol. 2011 Jan 11;57(2):173-80 Cohorts
IN anticoagulants, vitamin K antagonists, bleeding risk, elder patients The Use of
HAS-BLED score: Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly (1 point each, 0 = low risk, 1-2 = moderate, >=3 = high risk)
As Prognostic Item
Is better Than
other available scores
To predict risk of major haemorrhage under chronic warfarin: low risk 0.9% per patient-year, moderate 3.7%, high 6.7%.
J Gen Intern Med. 2005 Nov;20(11):1008-13 Cohorts
IN anticoagulants, vitamin K antagonists, bleeding risk, elder patients The Use of
outpatient bleeding risk index (BRI): 1 point for: age>65, history of stroke, history gastrointestinal bleeding, any of following (diabetes, recent myocardial infartion, anemia, creat>1.5mg/L)
As Prognostic Item
Is useful Than
intuitive assesment of bleeding risk
To predict risk of major haemorrhage under chronic warfarin: high-risk 10.6% per patient-year, intermediate 2.5%, and low-risk only 0.8% per year.
Stroke. 2009 Apr;40(4):1410-6 Meta-Analysis
IN atrial fibrillation, anticoagulants, vitamin K antagonists, bleeding risk, elder patients, stroke, ischemic, cerebral infarction, embolic The Use of
age
As Etiologic risk factor
Is useful Than
-
To predict an increased risk of stroke (HR per decade 1.45), major bleeding (HR per decade 1.61) and cardiovascular events (HR per decade 1.45). However the relative benefit of warfarin for preventing stroke persisted, while that of aspirin decreased
Lancet. 2007 Aug 11;370(9586):493-503 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, elder patients, not high haemorrahgic risk, not high stroke risk, anticoagulants, vitamin K antagonists, bleeding risk, elder patients The Use of
warfarin, antivitamin K
As Treatment, Chronic
Is better Than
aspirin
To reduce all-type strokes: 1.8% warfarin versus 3.8% aspirin. No increase at all in major haemorrhages.