@article{Hanna_Hyppa_Prakash_Vithanarachchi_Dawar_Sanga_Olabode_Crisp_Khalafallah_2021, title={REAL WORLD DATA ON CHARACTERISTICS AND MANAGEMENT OF COMMUNITY PATIENTS RECEIVING ANTICOAGULATION THERAPY WHO PRESENTED WITH ACUTE BLEEDING TO THE EMERGENCY DEPARTMENT AT A REGIONAL AUSTRALIAN HOSPITAL: A PROSPECTIVE OBSERVATIONAL STUDY.: Anticoagulation and bleeding ?}, volume={13}, url={https://www.mjhid.org/mjhid/article/view/4439}, DOI={10.4084/mjhid.2021.017}, abstractNote={<p><strong>Objective: </strong>To study patients receiving anticoagulants with or without antiplatelet therapy presenting at a regional Australian hospital with bleeding.  The main aims are to explore: (1) patients’ characteristics and management provided; (2) association between the type of anticoagulant and antiplatelet agent used and the requirement of reversal;  (3) and the length of hospital stay (LoS) in conjunction with bleeding episode and management.</p> <p><strong>Methods: </strong>A prospective cross-sectional review of medical records of all patients who presented at a tertiary referral centre with bleeding while receiving anticoagulation therapy between January 2016 and June 2018. Data included: demographics, investigations (kidney and liver function tests, coagulation profile, FBC), LoS, bleeding site, type of and reason for anticoagulation therapy, and management provided. Data analysis included descriptive statistics, ?<sup>2</sup> association, and regression models.</p> <p><strong>Results: </strong>Among the 144 eligible patients, 75 (52.1%) were male, and the mean age was 76 years (<em>SD</em>=11.1). Gastrointestinal tract bleeding was the most common (<em>n</em>=48, 33.3%), followed by epistaxis (<em>n</em>=32, 22.2%). Atrial fibrillation was the commonest reason for anticoagulation therapy (<em>n</em>=65, 45.1%). Warfarin was commonly used (<em>n</em>=74, 51.4%), followed by aspirin <em>(n</em>=29, 20.1%), rivaroxaban (<em>n</em>=26, 18.1%), and apixaban (<em>n</em>=12, 8.3%). A majority had increased blood urea nitrogen (<em>n</em>=67, 46.5%), while 58 (40.3%) had an elevated serum creatinine level, and 59 (41.0%) had a mild reduction in eGFR. Thirty-five of the warfarinised patients (47.3%) had an INR above the target range of their condition despite normal liver function. Severe anaemia (Hb<80g/L) was reported in 88 patients (61.1%). DOACs were associated with a reduced likelihood of receiving reversal (<em>B</em>= -1.7, <em>P</em>=<.001), and with a shorter LoS (<em>B</em>= -4.1, P=.046) when compared with warfarin, LMWH, and antiplatelet therapy.</p> <p><strong>Conclusion: </strong>Warfarin use was common among patients who presented with acute bleeding, and the INR in many warfarinised patients exceeded the target for their condition. DOACs were associated with a reduced likelihood for receiving reversal and with a shorter LoS when compared to warfarin, LMWH, which might support wider application of DOACs into community practice. </p>}, number={1}, journal={Mediterranean Journal of Hematology and Infectious Diseases}, author={Hanna, Fayez and Hyppa, Annemarie and Prakash, Ajay and Vithanarachchi, Usira and Dawar, Hizb U and Sanga, Zar and Olabode, George and Crisp, Hamish and Khalafallah, Alhossain A.}, year={2021}, month={Feb.}, pages={e2021017} }