Low-dose Anticoagulation Therapy With Rivaroxaban And Apixaban: How Are Bleeding Events Handled In A Veteran Based Population?
Ashwin Ghadiyaram, Sonia Lele, James Dittman, Diana Otoya, MD, Kedar Lavingia, MD, Michael F. Amendola, MD.
VA Medical Center/VCU Health System, Richmond, VA, USA.
INTRODUCTION:
Xarelto (X; Rivaroxaban) and Eliquis (E; Apixaban) are two oral Factor 10A inhibitor anticoagulants used in patients with vascular disease. Despite the protective effects of these medications even at low doses, there still exists the risk of hemorrhages in patients on these medications requiring either supportive treatment and/or reversal (AndexXa; Alexion Pharmaceuticals, Inc.). We wished to see how providers within a VA Health Care System were handling low dose Factor 10A Inhibitor’s bleeding events. METHODS:
After obtaining IRB approval, a Veterans Administration Anticoagulation Therapy database over an approximate six-month period (December 5, 2020 to June 3, 2021) at the Central Virginia VA Health Care System in Richmond, VA was accessed. All patients were followed after starting on low dose Xarelto (X; 2.5 mg BID) or Eliquis (E; 2.5 mg BID). Patients were followed for bleeding outcomes (major or minor), if blood transfusion was utilized, length of hospital stay, hospital days due to bleed and bleeding treatment utilized. Patient factors examined included diabetes mellitus, coronary artery disease, myocardial infarction, smoking, hypertension, number of antihypertensive drugs, acute limb ischemia, peripheral vascular disease, heart failure, atrial fibrillation, transient ischemic attack, cerebrovascular accident, aspirin usage, Plavix (clopidogrel) usage, beta blocker usage, statin usage, GFR and mortality. Unpaired t-tests* and Chi-Squares** were utilized to assess cohort differences. RESULTS:
There were 90 patients examined during the time period (X=18 and E=72). 14.4% (n=13) of patients had an average of 1.5 ± 0.77 bleeding events. Manifestation of bleed included gastrointestinal (n=5), hematuria (n=5), trauma (n=3) and other in three events. There were no significant differences in demographics, comorbidities nor type of Factor 10A inhibitor between the two groups. The bleeding group had a tendence toward increased time on either medication. Bleeding patients required on average 3.0 ± 1.7 units of blood and had additional hospital days of 4.7 ± 2.0 days. The major treatment in most all patients was to hold the anticoagulant. There were no deaths related to medication complication in either group. CONCLUSION:
In review of bleeding events in patients on low dose two common oral Factor 10A inhibitors found similar thrombosis and bleeding events. The treatment for these bleeding events relied solely on the conservative management despite the availability of a reversal agent.
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