Clinical Outcomes after Hospitalization for Oral Anticoagulant-Related Bleeding
Notice bibliographique
Résumé
Background: Use of oral anticoagulant (OAC) therapy for the prevention and treatment of thromboembolism is limited by serious bleeding complications, the most common OAC-related adverse event resulting in emergency department (ED) visits, hospitalization, and death. There are limited data regarding patient outcomes after hospitalization for OAC-related bleeding. Our objectives were to describe the risk of death, recurrent bleeding, and thromboembolism [deep vein thrombosis, pulmonary embolism, myocardial infarction, ischemic stroke] after hospitalization for OAC-related bleeding, and to identify risk factors for these outcomes. Methods: Using administrative healthcare data from Ontario, Canada, we conducted a population-based cohort study of adults aged >65 years who were discharged after incident hospitalization for bleeding with OAC dispensed in the preceding 100 days (April 1, 2012 - March 31, 2020). The primary outcome was mortality within 100 days after hospital discharge. Secondary outcomes were the cumulative incidence of all-cause mortality within 1 year, and hospital and ED admissions for bleeding and thromboembolism. We examined associations between baseline covariates and mortality using multivariable Cox regression models to calculate adjusted hazard ratios (HR) and 95% confidence intervals (CI), and Fine-Gray regression models to calculate adjusted sub-distribution HR and 95%CI for thrombosis, bleeding, and mortality. Results :Among 16180 cohort members, 14414 (89%) survived the index hospitalization and were included. Index bleeds were gastrointestinal (GI; n=9450, 66%), intracranial (n=1750, 12 %), genitourinary (GU; n=1178, 8%) or other (n=2036, 14%). The mean age was 81 years and 47% were female. Atrial fibrillation was the main indication for OAC (n=9,351, 65%). Patients were frequently prescribed factor Xa inhibitors (51%) and warfarin (39%). Within 100 days of discharge, OACs were dispensed to 9420 patients (65%), 87% of whom were prescribed a factor Xa inhibitor. Within 100 days of discharge, 28% of patients were re-hospitalized. The estimated cumulative incidence of mortality was 12% over 100 days and 24% over 1 year. Mortality was highest among individuals hospitalized for intracranial or GI bleeding over both 100 days (16% and 12%) and 1 year (26% and 24%). Using competing risk methods, the cumulative incidence of rebleeding was 11% (highest for index GI bleeding [11%]). The cumulative incidence of thromboembolism was 3% (highest for index GI bleeding [3%]). Baseline covariates associated with an increased risk of mortality were: cancer (HR 2.82; 95%CI 2.36-3.36), discharge to long-term care (ref: home, HR 2.06; 95%CI 1.82-2.34), Elixhauser comorbidity index ≥4 (HR 1.46; 95%CI 1.31-1.64), venous thromboembolism (ref: atrial fibrillation, HR 1.36; 95%CI 1.13-1.64), intracranial bleeding (ref: GU, HR 1.34; 95%CI 1.06-1.68), congestive heart failure (HR 1.35; 95%CI 1.22-1.50), dementia (HR 1.33; 95%CI 1.19-1.50), and increasing age (1-year older HR 1.05; 95%CI 1.04-1.06). Conclusion: Patients who survived hospitalization for OAC-related bleeding experienced substantial mortality, one-quarter dying within 1 year of hospital discharge. This confirms that older adults who are hospitalized for bleeding have a poor prognosis irrespective of index bleed site. The presence of cancer, discharge to long-term care and higher comorbidity burden had the strongest associations with mortality within 100 days. Evidence-based strategies are needed to identify and address risk factors to prevent OAC-related bleeding and to improve outcomes after serious bleeding.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».