| Title |
Natural history of bleeding and characteristics of early bleeders among warfarin initiators – a cohort study in Finland
|
|---|---|
| Published in |
Clinical Epidemiology, February 2016
|
| DOI | 10.2147/clep.s91379 |
| Pubmed ID | |
| Authors |
Maria Rikala, Helena Kastarinen, Pekka Tiittanen, Risto Huupponen, Maarit Jaana Korhonen |
| Abstract |
The demand for oral anticoagulant therapy will continue to increase in the future along with the aging of the population. This study aimed to determine the rate of bleeding requiring hospitalization and to characterize early bleeders among persons initiating warfarin therapy. Characterization of those most susceptible to early bleeding is important in order to increase the safety of warfarin initiation. Using data from nationwide health registers, we identified persons initiating warfarin therapy between January 1, 2009 and June 30, 2012, n=101,588, and followed them until hospitalization for bleeding, death, or administrative end of the study (December 31, 2012). We defined early bleeders as persons with a bleeding requiring hospitalization within 30 days since warfarin initiation. The rate of hospitalization for bleeding during a median follow-up of 1.9 years was 2.6% per person-year (95% confidence interval [CI] 2.5%-2.7%), with a peak within the first 30 days of warfarin initiation (6.5% per person-year, 95% CI 6.0%-7.1%). In a multivariable Cox proportional hazards regression analysis, early bleeders were characterized by prior bleeding (<180 days before initiation, hazard ratio [HR] =13.7, 95% CI 10.9-17.1; during 180 days-7 years before initiation, HR =1.48, 95% CI 1.15-1.90), male sex (HR =1.32, 95% CI 1.10-1.57), older age (HR =1.13, 95% CI 1.04-1.22, per 10-year increase), venous thrombosis (HR =1.83, 95% CI 1.44-2.34), pulmonary embolism (HR =1.46, 95% CI 1.11-1.91), alcohol abuse (HR =1.59, 95% CI 1.08-2.35), rheumatic disease (HR =1.40, 95% CI 1.07-1.83), and exposure to drugs with dynamic interaction mechanism with warfarin (HR =1.43, 95% CI 1.20-1.71). In age-adjusted models, Charlson comorbidity index and number of drugs predicted a graded increase in the hazard of early bleeding. The rate of hospitalizations for bleeding peaked in the beginning of warfarin therapy. Early bleeders were characterized by venous thrombosis, pulmonary embolism, and factors that increase bleeding risk without affecting the international normalized ratio. |
X Demographics
The data shown below were collected from the profiles of 3 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| El Salvador | 1 | 33% |
| Unknown | 2 | 67% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 2 | 67% |
| Practitioners (doctors, other healthcare professionals) | 1 | 33% |
Mendeley readers
The data shown below were compiled from readership statistics for 40 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United States | 1 | 3% |
| Unknown | 39 | 98% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Researcher | 7 | 18% |
| Student > Master | 6 | 15% |
| Student > Ph. D. Student | 4 | 10% |
| Student > Bachelor | 3 | 8% |
| Student > Postgraduate | 3 | 8% |
| Other | 9 | 23% |
| Unknown | 8 | 20% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 17 | 43% |
| Pharmacology, Toxicology and Pharmaceutical Science | 5 | 13% |
| Psychology | 3 | 8% |
| Unspecified | 1 | 3% |
| Sports and Recreations | 1 | 3% |
| Other | 1 | 3% |
| Unknown | 12 | 30% |
Attention Score in Context
This research output has an Altmetric Attention Score of 7. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 19 March 2019.
All research outputs
#4,436,180
of 23,905,714 outputs
Outputs from Clinical Epidemiology
#184
of 752 outputs
Outputs of similar age
#75,692
of 403,200 outputs
Outputs of similar age from Clinical Epidemiology
#2
of 4 outputs
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