Patients with atrial fibrillation who booty the claret thinner dabigatran are at greater accident for above bleeding and gastrointestinal bleeding than those who booty warfarin, according to a new abstraction by advisers at the University of Pittsburgh Graduate School of Public Health.
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The findings, based on Medicare claims abstracts and appear today in JAMA Internal Medicine, announce greater attention is bare aback prescribing dabigatran to assertive high-risk patients.
Atrial fibrillation, an arrhythmia in which the heart's aerial accommodation anyhow contract, can accelerate tiny clots from the affection to the claret argosy in the brain, explained the study's chief columnist Yuting Zhang, Ph.D., accessory assistant and administrator of the Pharmaceutical Economics Research Accumulation in Pitt Public Health's Department of Health Policy and Management. For that reason, these patients generally are assigned a claret thinner to absolute array accumulation with the aim of preventing strokes.
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"Dabigatran was alien in 2010 and, at the time of approval, it was the alone accessible another to warfarin," Dr. Zhang said. "Warfarin dosing can be catchy and approved ecology with claret tests is required, so doctors and patients were animated to accept a biologic that was easier to manage. But some contempo studies advance that dabigatran is associated with a college accident of bleeding."
To investigate that possibility, the study's aboriginal author, Inmaculada Hernandez, Pharm.D., Pitt Public Health, and the aggregation looked aback at pharmacy and medical claims data, which apply a different identifier cipher rather than accommodating names, from 2010 and 2011 of a accidental civic sample of Medicare beneficiaries. They tracked 1,302 dabigatran users and 8,102 warfarin users to see whether they accomplished bleeding episodes, classifying the contest as major, such as intracranial bleeding or gastrointestinal bleeding acute a hospital or emergency allowance stay, or minor, such as gastrointestinal bleeding that was advised on an outpatient basis, or adenoids bleeds.
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They additionally looked added carefully at bleeding episodes in four high-risk subgroups: those who were 75 and older; African-Americans; those with abiding branch disease; and those with seven or added co-existing medical problems.
Medicare abstracts showed that the accident of above bleeding was 9 percent and of any bleeding was 32.7 percent in the dabigatran accumulation and 5.9 percent and 26.6 percent, respectively, in the warfarin group. In added words, dabigatran users were 58 percent added acceptable to accept a above drain and 30 percent added acceptable to accept any affectionate of drain than those demography warfarin. African-Americans and patients with abiding branch ache application dabigatran were about alert as acceptable to accept a above drain as those demography warfarin. In addition, dabigatran users were added acceptable than warfarin users to acquaintance gastrointestinal or vaginal bleeding, or claret in the urine, joints or sputum. However, the dabigatran accumulation had a lower accident for bleeding in the brain.
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"These allegation announce that physicians should be alert aback prescribing dabigatran, decidedly to African-Americans and patients with branch impairments," Dr. Hernandez said. "Also, the accident of gastrointestinal bleeding was aerial in all the subgroups, so we acclaim doctors explain to patients how to ascertain it so that it can be advised promptly."
"We plan to appraise 2012 abstracts to adviser the accident of achievement for patients on dabigatran, which is the primary adumbration for demography the claret thinner," Dr. Zhang said. "It's accessible that for some patients a greater abridgement in the accident of achievement will outweigh the college accident of bleeding with dabigatran compared to warfarin."
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Explore further: ESC: Complications acclaimed afterwards dabigatran affection valve Tx
More information: JAMA Intern Med. Appear online November 3, 2014. DOI: 10.1001/jamainternmed.2014.5398
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