Novel Approach of Antithrombotic Potency Amongst Patients Admitted to Hospital with Bleeding Using HEMORR2HAGES Score: A Retrospective Cohort Study
DOI:
https://doi.org/10.1532/hsf.2645Abstract
Background: The purpose of this study was to evaluate whether a relationship exists between baseline
HEMORR2HAGES score and antithrombotic potency amongst patients presenting with bleeding complication. We hypothesized that the more antithrombotic regimen potency, the less HEMORR2HAGES score you have.
Methods: This is a retrospective observational study of patients admitted with a diagnosis of active bleeding between November 1, 2013 and August 31, 2015. The antithrombotic groups included patients on the following regimens: single antiplatelet therapy (SAP), single oral anticoagulant therapy (SOAC), dual antiplatelet therapy (DAPT), dual combination (SOAC+SAP), and triple antithrombotic therapy. The primary outcome was to review the mean HEMORR2HAGES score among the various groups.
Results: There were a total of 180 patients in the study. No significant difference was noted among the five groups in the HEMORR2HAGES score (P = .36). The highest
HEMORR2HAGES score was in the SAP group (3.23 ± 1.1). The lowest HEMORR2HAGES score was in the DAPT group (2.59 ± 1.2). In the Sub Group analysis, we compared single versus dual versus triple therapy, and we found the lowest HEMORR2HAGES score in the triple therapy group (2.70 ± 1.6); (P = .29).
Conclusions: Among patients admitted with active bleeding, the HEMORR2HAGES score did not differentiate antithrombotic potency amongst groups with various regimens. This study highlights the necessity to evaluate antithrombotic therapy according to benefits and harms.
References
Andrade JG, Deyell MW, Khoo C, et al. 2013. Risk of bleeding on triple antithrombotic therapy after percutaneous coronary intervention/stenting: a systematic review and meta-analysis. Can J Cardiol 29:204e212.
Apostolakis S, Lane DA, Guo Y, et al. 2012. Performance of the HEMORR2HAGES, ATRIA, and HAS-BLED bleeding risk-prediction scores in patients with atrial fibrillation undergoing anticoagulation: the AMADEUS (evaluating the use of SR34006 compared to warfarin or acenocoumarol in patients with atrial fibrillation) study. J Am Coll Cardiol 60:861–7.
D’Ascenzo F, Bollati M, Clementi F, et al. 2013. Incidence and predictors of coronary stent thrombosis: evidence from an international collaborative meta-analysis including 30 studies, 221,066 patients, and 4276 thromboses. Int J Cardiol 167:575e584.
Fang MC, Go AS, Chang Y, et al. 2011. A new risk scheme to predict warfarin-associated hemorrhage: the ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) study. J Am Coll Cardiol 58: 395– 401.
Gage BF, Yan Y, Milligan PE, et al. 2006. Clinical classification for predicting hemorrhages: results from the National Registry of Atrial Fibrillation (NRAF). Am Heart J. 151:713-9.
Hansen ML, Sorensen R, Clausen MT, et al. 2010. Risk of bleeding with single, dual, or triple therapy with warfarin, aspirin, and clopidogrel in patients with atrial fibrillation. Arch Intern Med 170:1433.
January CT, Wann LS, Calkins H, et al. 2019. AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: A report of the American college of cardiology/American heart association task force on clinical practice guidelines and the heart rhythm society. Heart Rhythm Jan 28. pii: S1547-5271(19)30037-2.
Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, Nelson ME, Wells PS, Gould MK, Dentali F, Crowther M, Kahn SR. 2012. Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 141:e419S–e494S.
Klolk FA, Niemann C, Dellas C, et al. 2016. Performance of five different bleeding-prediction scores in patients with acute pulmonary embolism. J Thromb Thrombolysis 2:312-20.
Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitz- Maurice D, Galie N, Gibbs JS, Huisman MV, Humbert M, Kucher N, Lang I, Lankeit M, Lekakis J, Maack C, Mayer E, Meneveau N, Perrier A, Pruszczyk P, Rasmussen LH, Schindler TH, Svitil P, Vonk NA, Zamorano JL, Zompatori M. 2014. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism: the task force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC) Endorsed by the European Respiratory Society (ERS). Eur Heart J 35:3033–3069.
Lamberts M, Olesen JB, Ruwald MH, et al. 2012. Bleeding after initiation of multiple antithrombotic drugs, including triple therapy, in atrial fibrillation patients following myocardial infarction and coronary interventions: a nationwide cohort study. Circulation 126:1185-1193.
Orford JL, Fasseas P, Melby S, et al. 2004. Safety and efficacy of aspirin, clopidogrel, and warfarin after coronary stent placement in patients with an indication for anti- coagulation. Am Heart J 147:463e467.
Pisters R, Lane DA, Nieuwlaat R, et al. 2010. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest 138:1093–100.
Rubboli A, Halperin JL, Airaksinen KE, et al. 2008. Antithrombotic therapy in patients treated with oral anticoagulation undergoing coronary artery stenting. An expexrt consensus document with focus on atrial fibrillation. Ann Med 40:428.
Sorensen R, Hansen ML, Abildstrom SZ, et al. 2009. Risk of bleeding in patients with acute myocardial infarction treated with different combinations of aspirin, clopidogrel, and vitamin K antagonists in Denmark: a retrospective analysis of nationwide registry data. Lancet 374:1967.
Zalesak M, Siu K, Francis K, et al. 2013. Higher persistence in newly diagnosed nonvalvular atrial fibrillation patients treated with dabigatran versus warfarin. Circ Cardiovasc Qual Outcomes 5:567-74.
Zhao HJ, Zheng ZT, Wang ZH, et al. 2011. “Triple therapy” rather than “triple threat”: a meta-analysis of the two antithrombotic regimens after stent implantation in patients receiving long-term oral anticoagulant treatment. Chest 139:260e270.
Published
How to Cite
Issue
Section
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).
