Risk of Lower and upper gastrointestinal bleeding, transfusions, and hospitalizations with complex antithrombotic therapy in elderly patients

Neena Susan Abraham, Christine Hartman, Peter Richardson, Diana Castillo, Richard L. Street, Aanand D. Naik

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

BACKGROUND - : Complex antithrombotic therapy (CAT) prescribed to elderly patients increases the risk of gastrointestinal bleeding. We quantified upper (UGIE) and lower gastrointestinal (LGIE) events, transfusions, and hospitalizations in a national cohort of elderly veterans prescribed CAT. METHODS AND RESULTS - : Veterans ≥60 years of age prescribed anticoagulant-Antiplatelet, aspirin (ASA)-Antiplatelet, ASA-Anticoagulant, or triple therapy (ie, TRIP, anticoagulant-Antiplatelet-ASA) were identified from the national pharmacy database (October 1, 2002 to September 30, 2008). Prescription-fill data were linked to Veteran Affairs and Medicare encounter files, each person-day of follow-up was assessed for CAT exposure, and outcomes were defined by using diagnostic code algorithms derived following chart abstraction. Incidence density ratios (compared with the reference category of no CAT) and survival analysis was conducted. Among 78 133 veterans (98.6% white; mean age, 72.3 [standard deviation 7.7]), 64% were prescribed ASA-Antiplatelet and anticoagulant-Antiplatelet and 6% were prescribed TRIP. The incidence of UGIE was 20.1/1000 patient-years, and the incidence of LGIE was 70.1/1000 patient-years. ASA-Anticoagulant and TRIP were associated with the highest incidence of transfusion and hospitalization. A 40% to 60% increased risk of UGIE was observed with all strategies. LGIE was 30% higher with anticoagulant-Antiplatelet, and transfusion increased with ASA-Anticoagulant (hazard ratio, 6.1; 95% confidence interval, 5.2-7.1) and TRIP (hazard ratio, 5.0; 95% confidence interval, 4.2-5.8). Increased risk of hospitalization was noted with all strategies. The number needed to harm for UGIE or LGIE ranged from 52 to 65 and 15 to 23, respectively. The number needed to harm for hospitalization was 39 (anticoagulant-Antiplatelet), 34 (ASA-Anticoagulant), 67 (ASA-Antiplatelet), and 45 (TRIP) patients. CONCLUSIONS - : Among elderly patients, CAT-related LGIE and UGIE are clinically relevant risks resulting in increased hospitalizations and transfusions.

Original languageEnglish (US)
Pages (from-to)1869-1877
Number of pages9
JournalCirculation
Volume128
Issue number17
DOIs
StatePublished - Oct 22 2013

Fingerprint

Anticoagulants
Hospitalization
Hemorrhage
Veterans
Therapeutics
Incidence
Implosive Therapy
Confidence Intervals
Survival Analysis
Medicare
Aspirin
Prescriptions
Databases

Keywords

  • antiplatelet agents
  • antithrombotic agents
  • assessment, patient outcome
  • blood component transfusion
  • hospitalization

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Risk of Lower and upper gastrointestinal bleeding, transfusions, and hospitalizations with complex antithrombotic therapy in elderly patients. / Abraham, Neena Susan; Hartman, Christine; Richardson, Peter; Castillo, Diana; Street, Richard L.; Naik, Aanand D.

In: Circulation, Vol. 128, No. 17, 22.10.2013, p. 1869-1877.

Research output: Contribution to journalArticle

Abraham, Neena Susan ; Hartman, Christine ; Richardson, Peter ; Castillo, Diana ; Street, Richard L. ; Naik, Aanand D. / Risk of Lower and upper gastrointestinal bleeding, transfusions, and hospitalizations with complex antithrombotic therapy in elderly patients. In: Circulation. 2013 ; Vol. 128, No. 17. pp. 1869-1877.
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AU - Hartman, Christine

AU - Richardson, Peter

AU - Castillo, Diana

AU - Street, Richard L.

AU - Naik, Aanand D.

PY - 2013/10/22

Y1 - 2013/10/22

N2 - BACKGROUND - : Complex antithrombotic therapy (CAT) prescribed to elderly patients increases the risk of gastrointestinal bleeding. We quantified upper (UGIE) and lower gastrointestinal (LGIE) events, transfusions, and hospitalizations in a national cohort of elderly veterans prescribed CAT. METHODS AND RESULTS - : Veterans ≥60 years of age prescribed anticoagulant-Antiplatelet, aspirin (ASA)-Antiplatelet, ASA-Anticoagulant, or triple therapy (ie, TRIP, anticoagulant-Antiplatelet-ASA) were identified from the national pharmacy database (October 1, 2002 to September 30, 2008). Prescription-fill data were linked to Veteran Affairs and Medicare encounter files, each person-day of follow-up was assessed for CAT exposure, and outcomes were defined by using diagnostic code algorithms derived following chart abstraction. Incidence density ratios (compared with the reference category of no CAT) and survival analysis was conducted. Among 78 133 veterans (98.6% white; mean age, 72.3 [standard deviation 7.7]), 64% were prescribed ASA-Antiplatelet and anticoagulant-Antiplatelet and 6% were prescribed TRIP. The incidence of UGIE was 20.1/1000 patient-years, and the incidence of LGIE was 70.1/1000 patient-years. ASA-Anticoagulant and TRIP were associated with the highest incidence of transfusion and hospitalization. A 40% to 60% increased risk of UGIE was observed with all strategies. LGIE was 30% higher with anticoagulant-Antiplatelet, and transfusion increased with ASA-Anticoagulant (hazard ratio, 6.1; 95% confidence interval, 5.2-7.1) and TRIP (hazard ratio, 5.0; 95% confidence interval, 4.2-5.8). Increased risk of hospitalization was noted with all strategies. The number needed to harm for UGIE or LGIE ranged from 52 to 65 and 15 to 23, respectively. The number needed to harm for hospitalization was 39 (anticoagulant-Antiplatelet), 34 (ASA-Anticoagulant), 67 (ASA-Antiplatelet), and 45 (TRIP) patients. CONCLUSIONS - : Among elderly patients, CAT-related LGIE and UGIE are clinically relevant risks resulting in increased hospitalizations and transfusions.

AB - BACKGROUND - : Complex antithrombotic therapy (CAT) prescribed to elderly patients increases the risk of gastrointestinal bleeding. We quantified upper (UGIE) and lower gastrointestinal (LGIE) events, transfusions, and hospitalizations in a national cohort of elderly veterans prescribed CAT. METHODS AND RESULTS - : Veterans ≥60 years of age prescribed anticoagulant-Antiplatelet, aspirin (ASA)-Antiplatelet, ASA-Anticoagulant, or triple therapy (ie, TRIP, anticoagulant-Antiplatelet-ASA) were identified from the national pharmacy database (October 1, 2002 to September 30, 2008). Prescription-fill data were linked to Veteran Affairs and Medicare encounter files, each person-day of follow-up was assessed for CAT exposure, and outcomes were defined by using diagnostic code algorithms derived following chart abstraction. Incidence density ratios (compared with the reference category of no CAT) and survival analysis was conducted. Among 78 133 veterans (98.6% white; mean age, 72.3 [standard deviation 7.7]), 64% were prescribed ASA-Antiplatelet and anticoagulant-Antiplatelet and 6% were prescribed TRIP. The incidence of UGIE was 20.1/1000 patient-years, and the incidence of LGIE was 70.1/1000 patient-years. ASA-Anticoagulant and TRIP were associated with the highest incidence of transfusion and hospitalization. A 40% to 60% increased risk of UGIE was observed with all strategies. LGIE was 30% higher with anticoagulant-Antiplatelet, and transfusion increased with ASA-Anticoagulant (hazard ratio, 6.1; 95% confidence interval, 5.2-7.1) and TRIP (hazard ratio, 5.0; 95% confidence interval, 4.2-5.8). Increased risk of hospitalization was noted with all strategies. The number needed to harm for UGIE or LGIE ranged from 52 to 65 and 15 to 23, respectively. The number needed to harm for hospitalization was 39 (anticoagulant-Antiplatelet), 34 (ASA-Anticoagulant), 67 (ASA-Antiplatelet), and 45 (TRIP) patients. CONCLUSIONS - : Among elderly patients, CAT-related LGIE and UGIE are clinically relevant risks resulting in increased hospitalizations and transfusions.

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