Evidence map›Paper›PMID 27520093›Full record

ArticleJournal of thrombosis and thrombolysis2016

Direct oral anticoagulant use and the incidence of bleeding in the very elderly with atrial fibrillation.

Fatima Khan, Hans Huang, Yvonne H Datta

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of thrombosis and thrombolysis, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
14citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

14 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Observational
  5. Article
  6. Safety of antithrombotic therapy in East Asian patients.Internal and emergency medicine · 2021
    Review
  7. Article
  8. Article
  9. Review
  10. Article
  11. Review
  12. Article
  13. Direct oral anticoagulant and antiplatelet combination therapy: Hemorrhagic events in coronary artery stent recipients.Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia · 2018
    Article
  14. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

3 authors.

Fatima KhanDivision of Hematology, Oncology and Transplantation, University of Minnesota Medical School, 420 Delaware St SE, MMC 480, Minneapolis, MN, 55455, USA.
Hans HuangDepartment of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
Yvonne H DattaDivision of Hematology, Oncology and Transplantation, University of Minnesota Medical School, 420 Delaware St SE, MMC 480, Minneapolis, MN, 55455, USA. datta009@umn.edu.

Funding

University of Minnesota Clinical and Translational Science Institute (UMN CTSI)UL1TR000114 · NCATS · UNIVERSITY OF MINNESOTA · PI BLAZAR, BRUCE R · 2012 to 2015
$35.0M
TRAINING IN HEMOGLOBIN &CELL MEMBRANE RESEARCHT32HL007062 · NHLBI · UNIVERSITY OF MINNESOTA TWIN CITIES · PI Jeffrey S. Miller, Gregory M Vercellotti · 1985 to 2026
$10.3M
NCATS NIH HHS UL1 TR000114NHLBI NIH HHS T32 HL007062
6 · The paper itself

Abstract

Atrial fibrillation (AF) is a major risk factor for stroke in the elderly population. The use of anticoagulation in patients with AF greatly reduces the risk for stroke, but results in an increased risk of bleeding. Over the past several years, direct oral anticoagulants (DOACs, dabigatran, rivaroxaban, and apixaban) have been used in place of warfarin for stroke prevention in AF. We conducted a retrospective cohort study to assess the safety of DOACs in very elderly patients (75+) managed in a health care system encompassing both community and academic settings. We found that 36 % of patients had moderate to severe renal failure (estimated glomerular filtration rate <59 ml/min/1.73 m(2)) at the time of DOAC initiation. 142 patients were followed for a mean of 2.56 years, and five experienced a major bleeding episode while on anticoagulation, for a rate of 1.37 per 100 person years. All major bleeding episodes were associated with a decline in GFR compared to baseline. There were 12 non-major bleeding episodes reported. HAS-BLED scores were similar for those patients who experienced bleeding complications compared to those who did not. 21 % of patients were prescribed an inappropriately low dose of DOAC based on approved recommendations. DOACs appear to be a safe form of anticoagulation in very elderly patients with AF. However, the decline in GFR among patients with major bleeding highlights the importance of routine renal function monitoring.

Indexed as

Administration, OralAgedAged, 80 and overAnticoagulantsAtrial FibrillationFemaleHemorrhageHumansIncidenceMaleRetrospective StudiesAnticoagulantsApixabanAtrial fibrillationBleedingDabigatranDirect oral anticoagulantsElderlyRivaroxaban

Identifiers

PMID27520093
PMCPMC5042846

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.