PB2428 REAL-WORLD EVALUATION OF BLEEDING EPISODES IN PATIENTS TREATED WITH NEWER ANTICOAGULANTS
Authors: N. Neokleous, A. Kotsiafti, E. Vetsiou, K. Kafantari, P. Klonizakis, X. Apostolou, E. Vlachaki
Journal: HemaSphere (2019)

Background: The use of newer anticoagulants is becoming widespread, with the latter increasingly gaining ground over coumarin derivatives. This category includes Dabigatran, Rivaroxaban and Apixaban. Dabigatran is a direct inhibitor of thrombin while Rivaroxaban and Apixaban are direct inhibitors of factor Xa. Lately, the newer anticoagulants tend to replace common aspirin to prevent thrombosis and stroke in patients with known ciliary atrial fibrillation. Ιn addition, the impracticality of monthly International Normalized Ratio (INR) was an advantage. However, various concerns arise about their correlation with bleeding. Aims: Herein, we report the effect of the newer anticoagulants among the patient population who have been referred to our clinic for the last eight months. Methods: We studied 50 patients who received Dabigatran, Rivaroxaban, Apixaban and Acenocoumarol. Twenty four of them were women.The median age range is 79 (58-95) years. The majority of the patients received anticoagulant treatment due to atrial fibrillation. Previous ischemic stroke and history of pulmonary embolism were other mentioned reasons for treatment initiation.In order to make a correlation based on Binary Logistic Program in SPSS we also used a sample of 37 patients who were hospitalized for other reasons. The latter did not receive anticoagulation or antiplatelet therapy and never had bleeding. All patients with hematologic conditions and those with hepatic insufficiency were excluded. Results: Initially, bleeding episodes have been reported in 38 patients (group 1) who received any of the Dabigatran, Rivaroxaban and Apixaban and in 12 patients (group 2) who received Acenocoumarol (table1). In order to correlate the occurrence of bleeding in a patient receiving Dabigatran, Rivaroxaban and Apixaban versus the general population based on actual clinical data, we performed a statistical analysis using the SPSS statistic program. According to the results of Logistic Regression, we calculated Odds Ratio (OR) and P-value. Neither the anticoagulant treatment (OR = 0.719 at 95% CI and P-value (Sig) = 0.429) nor the age of 75 years (OR = 0.711 and P-value 0.418) play any statistically significant role in the occurrence of bleeding episodes. Using the Chi-Square Tests method, it is proven that there is no anticoagulant (Dabigatran, Rivaroxaban, Apixaban, Acenocoumarol) that outweighs the others concerning the number of provoked bleeding episodes.Summary/Conclusion: NOACs offer important safety advantages over VKAs because they are at least as effective for the prevention of thromboembolism, they are associated with lower rates of life-threateningand intracranial bleeding, and they are more convenient because they can be given in fixed doses without routine coagulation monitoring. Our study reports real life results that proved that the newer anticoagulantsare not associated with increased risk of bleeding episodes. More research is needed to define the specific factors and circumstances that lead to an hemorrhagic episode.