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.

Objective: 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.

Methods: 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: patients, 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, χ association, and regression models.

Results: Among the 144 eligible patients, 75 (52.1%) were male, and the mean age was 76 years (=11.1). Gastrointestinal tract bleeding was the most common (=48, 33.3%), followed by epistaxis (=32, 22.2%). Atrial fibrillation was the commonest reason for anticoagulation therapy (=65, 45.1%). Warfarin was commonly used (=74, 51.4%), followed by aspirin =29, 20.1%), rivaroxaban (=26, 18.1%), and apixaban (=12, 8.3%). The majority had increased blood urea nitrogen (=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 their condition's target range 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 (= -1.7, =<.001), and with a shorter LoS (= -4.1, P=.046) when compared with warfarin, LMWH, and antiplatelet therapy.

Conclusion: 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 of receiving reversal and a shorter LoS than warfarin, LMWH, which might support a broader application of DOACs into community practice.