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Resuming anticoagulation with dabigatran benefits patients with AF, major bleeding
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In patients with atrial fibrillation who had a major bleeding event on dabigatran or warfarin, resuming anticoagulation with dabigatran conferred better subsequent outcomes than resuming with warfarin or discontinuing anticoagulation, researchers found.
“If a patient who is on an anticoagulant to avoid a stroke has a major bleeding event, doctors are faced with a catch-22: Discontinue the anticoagulant to avoid major bleeding, but again place their patient at increased risk of stroke; or resume the anticoagulant to continue avoiding a stroke, but then have to worry about another bleeding event,” Inmaculada Hernandez, PharmD, PhD, assistant professor in the School of Pharmacy at the University of Pittsburgh, said in a press release.
Hernandez and colleagues evaluated anticoagulation use after a first major bleed and compared safety and effectiveness outcomes between patients with a first major bleed who discontinued anticoagulation, resumed with warfarin or resumed with dabigatran (Pradaxa, Boehringer Ingelheim).
Using Medicare Part D data from 2010 to 2012, the researchers identified 1,135 patients who had a major bleeding event while assigned warfarin and 404 who had a major bleeding event while assigned dabigatran. Patients were followed until the end of 2012 for ischemic stroke, recurrent hemorrhage or death.
Compared with discontinuation of anticoagulation, resumption with dabigatran (HR = 0.66; 95% CI, 0.44-0.99) and resumption with warfarin (HR = 0.76; 95% CI, 0.59-0.97) were associated with a lower combined risk for ischemic stroke and all-cause mortality, Hernandez and colleagues wrote.
Recurrent major bleeding occurred more often in patients who resumed anticoagulation with warfarin than in patients who resumed with dabigatran (HR = 2.31; 95% CI, 1.19-4.76) or in those who discontinued anticoagulation (HR = 1.56; 95% CI, 1.1-2.22), according to the researchers, who found no difference in bleeding events between those who resumed with dabigatran and those who did not resume anticoagulation (HR = 0.65; 95% CI, 0.32-1.33).
“Our results should encourage clinicians to seriously consider resuming anticoagulation among patients who survived a major bleeding event, particularly if the source of bleeding was identified and addressed,” Samir Saba, MD, associate professor of medicine and associate chief of cardiology at the University of Pittsburgh Medical Center Heart and Vascular Institute, said in the release. “They should also take into account that the benefit-to-risk ratio of post-hemorrhage use of anticoagulation is not the same for all medications.” – by Erik Swain
Disclosure: Saba reports receiving research support from Boston Scientific, Medtronic and St. Jude Medical. The other researchers report no relevant financial disclosures.
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