Acceptance of a potential major bleeding among patients with venous thromboembolism on long-term oral anticoagulation: the knowledge of the disease and therapy matters.
Bleeding ratio
Knowledge
Oral anticoagulation
Venous thromboembolism
Journal
Thrombosis research
ISSN: 1879-2472
Titre abrégé: Thromb Res
Pays: United States
ID NLM: 0326377
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
received:
21
03
2020
revised:
15
05
2020
accepted:
25
05
2020
pubmed:
15
6
2020
medline:
22
6
2021
entrez:
15
6
2020
Statut:
ppublish
Résumé
We investigated the bleeding tolerance and its determinants in anticoagulated patients with venous thromboembolism (VTE). In 153 outpatients after VTE which occurred in the absence of any identifiable risk factor (aged 52 ± 15.7 years, 54.9% male), anticoagulated for at least one month (for median 29, interquartile range [IQR] 11-72 months), the Bleeding Ratio was determined basing on the declared maximum number of major bleeds that patients can accept to prevent one similar recurrent VTE episode. The modified Jessa AF Knowledge Questionnaire (JAKQ-VTE) was used to assess the knowledge of VTE and anticoagulation. The median of the Bleeding Ratio was 4 (IQR 2-6, minimum 1, maximum 10). Compared with patients with a high Bleeding Ratio (≥4 accepted bleedings, n = 91, 59.5%), those with a low Bleeding Ratio (0-3 accepted bleedings, n = 62, 40.5%) more frequently suffered from isolated deep vein thrombosis (DVT), recurrent VTE, and diabetes. The low Bleeding Ratio group had lower overall scoring in the JAKQ-VTE compared with the remainder (median, 60.4% vs 67.6%, p = 0.003). The independent predictors of a low Bleeding Ratio were: age (odds ratio [OR], 1.36; 95% confidence interval [CI] 1.06-1.75), history of isolated PE (OR, 0.24; 95% CI, 0.08-0.66), scores in the JAKQ-VTE (OR, 0.74; 95% CI, 0.57-0.95), and time since VTE diagnosis (OR, 1.05; 95% CI, 0.98-1.13). The current study suggests that the acceptance of potential major bleedings is associated not only with age and clinical factors, but also with the knowledge of VTE and anticoagulation, which highlights the need for educational efforts among patients requiring long-term anticoagulant therapy.
Sections du résumé
BACKGROUND
We investigated the bleeding tolerance and its determinants in anticoagulated patients with venous thromboembolism (VTE).
METHODS
In 153 outpatients after VTE which occurred in the absence of any identifiable risk factor (aged 52 ± 15.7 years, 54.9% male), anticoagulated for at least one month (for median 29, interquartile range [IQR] 11-72 months), the Bleeding Ratio was determined basing on the declared maximum number of major bleeds that patients can accept to prevent one similar recurrent VTE episode. The modified Jessa AF Knowledge Questionnaire (JAKQ-VTE) was used to assess the knowledge of VTE and anticoagulation.
RESULTS
The median of the Bleeding Ratio was 4 (IQR 2-6, minimum 1, maximum 10). Compared with patients with a high Bleeding Ratio (≥4 accepted bleedings, n = 91, 59.5%), those with a low Bleeding Ratio (0-3 accepted bleedings, n = 62, 40.5%) more frequently suffered from isolated deep vein thrombosis (DVT), recurrent VTE, and diabetes. The low Bleeding Ratio group had lower overall scoring in the JAKQ-VTE compared with the remainder (median, 60.4% vs 67.6%, p = 0.003). The independent predictors of a low Bleeding Ratio were: age (odds ratio [OR], 1.36; 95% confidence interval [CI] 1.06-1.75), history of isolated PE (OR, 0.24; 95% CI, 0.08-0.66), scores in the JAKQ-VTE (OR, 0.74; 95% CI, 0.57-0.95), and time since VTE diagnosis (OR, 1.05; 95% CI, 0.98-1.13).
CONCLUSIONS
The current study suggests that the acceptance of potential major bleedings is associated not only with age and clinical factors, but also with the knowledge of VTE and anticoagulation, which highlights the need for educational efforts among patients requiring long-term anticoagulant therapy.
Identifiants
pubmed: 32535233
pii: S0049-3848(20)30209-7
doi: 10.1016/j.thromres.2020.05.037
pii:
doi:
Substances chimiques
Anticoagulants
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
116-121Informations de copyright
Copyright © 2020 Elsevier Ltd. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.