title: Frequency and predictors of bleeding complications associated with anti-coagulant therapy using dabigatran in Japanese patients with atrial fibrillation.
abstract: BACKGROUND
  Few data exist regarding frequency and predictors of bleeding complications associated with anticoagulant therapy using dabigatran in Japanese patients with atrial fibrillation (AF).
  
  
  RESULTS
  We retrospectively studied 184 patients with AF who were administered dabigatran from April 2011 to August 2012 in our institution. Twenty-eight patients (15%) developed some type of bleeding complication. In the Bleeding group, age, CHADS2 and HAS-BLED score were higher (75 vs. 71 years, p=0.067, 2.7 vs. 1.9, p=0.006 and 2.3 vs. 1.8, p=0.01, respectively), hemoglobin concentration was lower (13.1 vs. 13.7 g/dL, p=0.04), casual activated partial thromboplastin time (APTT) was longer (60.2 vs. 47.4 sec., p<0.0001) and frequency of aspirin use was higher (29 vs. 15%, p=0.09) than those in the Non-bleeding group. Multivariate regression analysis showed that casual APTT was an independent significant predictor of any type of bleeding complications (β=0.431, p<0.0001). Moreover, casual APTT (β=0.359, p=0.049), pre-existing anemia (β=0.457, p=0.02) and aspirin use (β=0.597, p=0.02) were significant predictors of major bleeding. ROC analysis showed that casual APTT exhibited 83.3% sensitivity and 72.5% specificity as predictors of major bleeding and its cut-off value was 54.7 sec.
  
  
  CONCLUSIONS
  Casual APTT level can serve as a predictor of bleeding complications, while pre-existing anemia and aspirin use may be associated with major bleeding in patients with AF treated with dabigatran.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Yokohama Sakae Kyosai Hospital, Federation of National Public Service Personnel Mutual Associations Yokohama, Japan.
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Katoh
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Yokohama Sakae Kyosai Hospital, Federation of National Public Service Personnel Mutual Associations Yokohama, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Nozue
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Yokohama Sakae Kyosai Hospital, Federation of National Public Service Personnel Mutual Associations Yokohama, Japan.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Asada
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Yokohama Sakae Kyosai Hospital, Federation of National Public Service Personnel Mutual Associations Yokohama, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Nakashima
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Yokohama Sakae Kyosai Hospital, Federation of National Public Service Personnel Mutual Associations Yokohama, Japan.
authors.forename: Yuya
authors.initials: Y
authors.lastname: Kimura
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Yokohama Sakae Kyosai Hospital, Federation of National Public Service Personnel Mutual Associations Yokohama, Japan.
authors.forename: Shimpei
authors.initials: S
authors.lastname: Ito
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Yokohama Sakae Kyosai Hospital, Federation of National Public Service Personnel Mutual Associations Yokohama, Japan.
authors.forename: Sei
authors.initials: S
authors.lastname: Nakata
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Yokohama Sakae Kyosai Hospital, Federation of National Public Service Personnel Mutual Associations Yokohama, Japan.
authors.forename: Taku
authors.initials: T
authors.lastname: Iwaki
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Yokohama Sakae Kyosai Hospital, Federation of National Public Service Personnel Mutual Associations Yokohama, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Michishita
keywords: Activated partial thromboplastin time; anticoagulant therapy; bleeding complication; dabigatran