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Bleeding risk and major adverse events in patients with previous ulcer on oral anticoagulation therapy

Authors
 Seung-Jun Lee  ;  Dong-Ho Shin  ;  Hye-Jin Hwang  ;  Jong-Youn Kim  ;  Hui-Nam Pak  ;  Moon-Hyoung Lee  ;  Boyoung Joung 
Citation
 American Journal of Cardiology, Vol.110(3) : 373-377, 2012 
Journal Title
 American Journal of Cardiology 
ISSN
 0002-9149 
Issue Date
2012
Abstract
Bleeding is the major concern for patients receiving oral anticoagulation therapy (OAT), especially those with histories of gastrointestinal ulcer. The aim of this study was to evaluate the efficacy and safety of OAT in patients with nonvalvular atrial fibrillation with histories of ulcer. A composite end point, including major adverse cardiac events or major bleeding, was compared between patients with AF with previous ulcers who were (OAT+; n = 200) and were not (OAT- n = 230) receiving OAT. During the follow-up period of 3.3 ± 2.7 years, 28 (14%) and 66 (29%) OAT+ and OAT- patients, respectively, had major adverse cardiac events (p = 0.001). Major bleeding occurred in 46 OAT+ patients (23%) and 25 OAT- patients (11%) (p = 0.001). There was no significant difference in the composite end point between OAT+ and OAT- patients (29% vs 36%, p = 0.08). The incidence of major bleeding was significantly lower, decreasing from 30% to 14%, when OAT began after endoscopic confirmation of ulcer healing (p = 0.02). OAT+ patients who achieved time in the therapeutic range ≥60% for international normalized ratio (2.0 to 3.0) demonstrated better cumulative survival free from the composite end point than OAT- patients (p = 0.01). In conclusion, OAT in patients with nonvalvular AF with histories of gastrointestinal ulcer made no difference in the composite end point compared to absence of OAT. In OAT+ patients, maintaining an optimal international normalized ratio reduced the composite end point, and the confirmation of ulcer healing reduced the incidence of bleeding.
Full Text
http://www.sciencedirect.com/science/article/pii/S0002914912010521
DOI
10.1016/j.amjcard.2012.03.036
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
김종윤(Kim, Jong Youn) ORCID logo https://orcid.org/0000-0001-7040-8771
박희남(Pak, Hui Nam) ORCID logo https://orcid.org/0000-0002-3256-3620
신동호(Shin, Dong Ho) ORCID logo https://orcid.org/0000-0002-7874-5542
이문형(Lee, Moon Hyoung) ORCID logo https://orcid.org/0000-0002-7268-0741
이승준(Lee, Seung Jun) ORCID logo https://orcid.org/0000-0002-9201-4818
정보영(Joung, Bo Young) ORCID logo https://orcid.org/0000-0001-9036-7225
황혜진(Hwang, Hye Jin)
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/89410
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