20 Jan History of Bleeding Helps Predict Risk of Bleeding from Anticoagulants
More on Anticoagulants on MedicalResearch.com
MedicalResearch.com Interview with:
Prof. Raffaele De Caterina M.D., Ph.D
University Cardiology Division G. d’Annunzio University
Medical Research: What is the background for this study? What are the main findings?
Dr. De Caterina: There is uncertainty on how to predict bleeding upon treatment with anticoagulants, because bleeding risk scores and thromboembolic risk score fare very similarly in predicting bleeding, making the net clinical benefit difficult to assess in the single patient. Here we find that a history of bleeding – even minor bleeding – has an important prognostic value on the risk of future bleeding – virtually all sorts of future bleeding, with the notable exception of intracranial hemorrhage. Some novel oral anticoagulants (NOACs), such as apixaban, studied here, reduce the risk of major bleeding, and appear to benefit independent of the bleeding history.
Medical Research: What should clinicians and patients take away from your report?
Dr. De Caterina: Clinicians should incorporate bleeding history as an important part of the patient’s work-up when prescribing anticoagulants in atrial fibrillation – although in most cases anticoagulant will still benefit most patients.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. De Caterina: We still have to understand whether subtypes of minor bleeding, e.g., gastrointestinal vs nose bleeds etc., may help differentiating the risk of specific types of future bleeding. We also need to better understand how to incorporate history of bleeding in the clinical decision-making.
History of Bleeding and Outcomes with Apixaban versus Warfarin in Patients with Atrial Fibrillation in the ARISTOTLE Trial
American Heart Journal , Volume 0 , Issue 0 ,
Published Online:January 18, 2016
Prof. Raffaele De Caterina M.D., Ph.D (2016). History of Bleeding Helps Predict Risk of Bleeding from Anticoagulants