Slightly elevated international normalized ratio predicts bleeding episodes in patients treated with direct oral anticoagulants

Priya Bhardwaj, Louise Breum Petersen, Tomas Sorm Binko, Jan Roland Petersen, Gitte Gleerup Fornitz*

*Corresponding author for this work
1 Citation (Scopus)

Abstract

Introduction: Patients treated with direct oral anticoagulants (DOACs) are at increased bleeding risk. It is therefore of increasing interest to identify predictors of bleeding episodes to increase safety during treatment with DOACs. Methods: This retrospective cohort study systematically reviewed medical records of 235 patients treated with either apixaban, rivaroxaban or dabigatran for non-valvular atrial fibrillation or venous thromboembolism and collected data on the international normalized ratio (INR) and all bleeding episodes. Results: INR ≥ 1.5 was significantly associated with increased risk of minor and major bleeding events in patients treated with direct factor Xa inhibitors. This association was not present in patients treated with dabigatran. However, a high negative predictive value was identified for INR < 1.5 for all drugs. The relative risks of bleeding episodes in patients with INR ≥ 1.5 and INR < 1.5 were 5.1 and 0.20, respectively. Conclusions: Our results demonstrate a strong correlation between INR and risk of bleeding episodes during DOAC treatment. INR < 1.5 was a strong negative predictor for low bleeding risk independent of indication or choice of drug, and INR ≥ 1.5 was associated with increased risk of bleeding episodes in patients treated with direct factor Xa-inhibitors.

Original languageEnglish
Article number0300060519894439
JournalJournal of International Medical Research
Volume48
Issue number6
Pages (from-to)1-9
Number of pages9
ISSN0300-0605
DOIs
Publication statusPublished - Jun 2020

Keywords

  • Direct oral anticoagulants
  • factor Xa inhibitors
  • international normalized ratio
  • major bleeding
  • minor bleeding
  • thrombin inhibitor

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