Respiratory Tract Infection and Bleeding Risk in Anticoagulant Users

Pavankumar Kamat

Disclosures

January 10, 2022

Takeaway

  • The risk of major bleeding and clinically relevant non-major bleeding (CRNMB) was more than 2-fold higher among oral anticoagulant users during the 0-14 days following a community-acquired respiratory tract infection (RTI) for which no antibiotics were prescribed.

Why this matters

  • Findings may have potential implications for how patients and clinicians manage oral anticoagulant use during an acute intercurrent illness.

Study design

  • A self-controlled case series included 1208 patients who were prescribed warfarin or a direct oral anticoagulant and those with an untreated community-acquired RTI, identified from the UK Clinical Practice Research Datalink (CPRD) GOLD database (2010-2019).

  • Main outcomes: incidence of major bleeding and CRNMB during the 0-14 days following an untreated RTI compared with unexposed time periods.

  • Funding: Health and Care Research Wales.

Key results

  • Overall, 395 major bleeds were reported, of which 292 were reported during 287,579 days of observation of the unexposed period and 41 were reported during 6710 days of observation of the 0-14 day risk window.

  • Overall, 1272 CRNMBs were reported, of which 1003 were reported during 827,042 days of observation of the unexposed period and 81 were reported during 23,166 days of observation of the 0-14 day risk window.

  • After adjustment for confounders, the relative incidence of major bleeding (incidence rate ratio [IRR], 2.68; 95% CI 1.83 to 3.93) and CRNMB (IRR, 2.32; 95% CI 1.82 to 2.94) was higher among oral anticoagulant users during the 0 to 14 days following an untreated RTI.

Limitations

  • Participants included only those that had consulted a healthcare professional for their RTI.

Ahmed H, Whitaker H, Farewell D, Hippisley-Cox J, Noble S. Respiratory tract infection and risk of bleeding in oral anticoagulant users: self-controlled case series. BMJ. 2021;375:e068037. doi: 10.1136/bmj-2021-068037. PMID: 34933893 View Full Text.

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