title: Management and Outcomes of Bleeding Events in Patients in the Emergency Department Taking Warfarin or a Non-Vitamin K Antagonist Oral Anticoagulant.
abstract: BACKGROUND
  Most comparisons of bleeding patients who are taking warfarin or a non-vitamin K oral anticoagulant (NOAC) have been limited to admitted patients and major bleeding events in well-controlled, clinical trial settings.
  
  
  OBJECTIVE
  We describe the clinical characteristics, interventions, and outcomes in patients who are taking warfarin or a NOAC who presented to the emergency department (ED) with any bleeding event.
  
  
  METHODS
  We conducted a structured, retrospective, observational study of nonvalvular atrial fibrillation, pulmonary embolism, or deep vein thrombosis warfarin- or NOAC-treated patients presenting with any bleeding event to a large, academic ED between January 2012 and March 2015. We used descriptive statistics to summarize baseline characteristics, treatments, and outcomes and performed subgroup analyses based on the type of anticoagulant and site of bleeding.
  
  
  RESULTS
  The electronic search yielded 95 cases of patients taking a NOAC (i.e., dabigatran [33], rivaroxaban [32], or abixaban [30]) and 342 patients taking warfarin. Reversal agents were rarely used in all anticoagulant groups. Case fatality rates were similar among warfarin- and NOAC-treated patients for gastrointestinal bleeding (7% vs. 7%) and intracranial hemorrhage (18% vs. 4%), respectively. After adjustment for other factors, only intracranial hemorrhage (odds ratio 4.4; 95% confidence interval 1.4-13.3) was associated with mortality.
  
  
  CONCLUSIONS
  Despite the rare use of reversal strategies, mortality was low and outcomes were comparable among patients with bleeding events presenting to the ED while taking a NOAC compared with warfarin.
authors: Department of Emergency Medicine, Stony Brook Medicine, Stony Brook, New York. Electronic address: adam.singer@stonybrook.edu.
authors: Adam J
authors: AJ
authors: Singer
authors: Department of Emergency Medicine, Stony Brook Medicine, Stony Brook, New York.
authors: Adam
authors: A
authors: Quinn
authors: Department of Emergency Medicine, Stony Brook Medicine, Stony Brook, New York.
authors: Neil
authors: N
authors: Dasgupta
authors: Department of Emergency Medicine, Stony Brook Medicine, Stony Brook, New York.
authors: Henry C
authors: HC
authors: Thode
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000494:pharmacology / Q000627:therapeutic use; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D006470:Hemorrhage / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D063868:Patient Outcome Assessment; D012189:Retrospective Studies; D014812:Vitamin K / Q000494:pharmacology / Q000627:therapeutic use; D014859:Warfarin / Q000009:adverse effects* / Q000037:antagonists & inhibitors
chemical_list: D000925:Anticoagulants; D014812:Vitamin K; D014859:Warfarin
keywords: NOACs; NVAF; VTE; anticoagulants; bleeding; warfarin