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Incidence and consequences of resuming oral anticoagulant therapy following hematuria and risks of ischemic stroke and major bleeding in patients with atrial fibrillation

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Abstract

Following hematuria, it is uncertain to what extent a vitamin K antagonist (VKA) or non-VKA oral anticoagulant (NOAC) is resumed, and the risks of ischemic stroke/systemic embolism and major bleeding associated with NOAC and VKA resumption are unknown. A cohort study was conducted using electronic medical records collected from 2009 to 2017 at a multicenter healthcare provider in Taiwan. The cohort included 4155 atrial fibrillation patients receiving anticoagulant therapy with hematuria (age: 71.4 ± 11.2 years; 48.8% female). Within 90 days following hematuria, 3287 patients (79.1%) resumed oral anticoagulants including VKA (n = 1554, 37.4%) and NOACs (n = 1733, 41.7%), whereas 868 patients did not resume anticoagulant. Follow-up was initiated 90 days after the occurrence of hematuria, and time-varying multiple Cox regression analyses were used for comparisons between the resumption of NOAC and VKA. The event rates per 100 person-years in the VKA resumption and NOAC resumption groups were 3.04 and 3.28 for ischemic stroke/systemic embolism, and 2.63 and 2.92 for major bleeding, respectively. Patients resuming NOAC had similar risks of ischemic stroke/systemic embolism (hazard ratio 1.14, 95% CI 0.75–1.74) and major bleeding (hazard ratio 1.12, 95% CI 0.72–1.74) compared with those resuming VKA. Since 2011, the proportion of NOAC resumption has increased, whereas the proportions of VKA resumption and non-resumption have decreased. In conclusion, more and more patients who suffer a hematuria while on oral anticoagulant therapy resume NOAC. Patients resuming NOAC have similar risks of ischemic stroke/systemic embolism and major bleeding compared with those resuming VKA.

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Acknowledgements

The authors thank the statistical assistance and wish to acknowledge the support of the Maintenance Project of the Center for Big Data Analytics and Statistics (Grant CLRPG3D0044) at Chang Gung Memorial Hospital for study design and monitor, data analysis and interpretation. This study is based in part on data from the Chang Gung Research Database provided by Chang Gung Memorial Hospital. The interpretation and conclusions contained herein do not represent the position of Chang Gung Memorial Hospital.

Funding

This work was funded by a research grant from the Chang Gung Memorial Hospital, Linkou, Taiwan (CMRPG3H0501).

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Authors and Affiliations

  1. Cardiovascular Division, Department of Internal Medicine, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan

    Chun-Li Wang, Victor Chien-Chia Wu, Pao-Hsien Chu, Ming-Shien Wen & Shang-Hung Chang

  2. College of Medicine, Chang Gung University, Taoyuan City, Taiwan

    Chun-Li Wang, Victor Chien-Chia Wu, Pao-Hsien Chu, Chang-Fu Kuo, Ming-Shien Wen & Shang-Hung Chang

  3. Center for Big Data Analytics and Statistics, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan

    Yu-Tung Huang, Yu-Ling Chen & Shang-Hung Chang

  4. Graduate Institute of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan

    Yu-Tung Huang & Shang-Hung Chang

  5. Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan

    Chang-Fu Kuo

  6. Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK

    Chang-Fu Kuo

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Wang, CL., Wu, V.CC., Huang, YT. et al. Incidence and consequences of resuming oral anticoagulant therapy following hematuria and risks of ischemic stroke and major bleeding in patients with atrial fibrillation. J Thromb Thrombolysis 51, 58–66 (2021). https://doi.org/10.1007/s11239-020-02135-2

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