OC 20.3 - Mortality and Health Resource Utilization During Hospitalization for Anticoagulant-Related Bleeding

Background: Oral anticoagulant (OAC) related bleeding is the most common adverse drug event leading to emergency department visits, hospital admissions and death. However, there are limited bleed-specific data regarding outcomes during hospitalization.

Aims: To examine healthcare utilization and mortality during hospitalization for OAC related bleeding.

Methods: Using linked administrative and clinical health databases in Ontario, Canada, we conducted a population-based cohort study of adults >65 years with an incident hospitalization for bleeding and OAC dispensation in the preceding 100 days. The primary outcome was in-hospital mortality. Secondary outcomes included 30-day mortality, duration of hospitalization, intensive care unit (ICU) admission, and discharge to long-term care. We calculated the crude mortality rate overall and according to bleed site. We used Cox regression modelling to examine associations between baseline characteristics and mortality.

Results: Overall, 16,180 individuals were admitted with gastrointestinal (10,010, 61.9%), intracranial (2,838, 17.5%), genitourinary (1,189, 7.3%), or other bleeding (2,143, 13.2%). The mean age was 82 years and 47% were female. Most individuals were treated for atrial fibrillation (65%) and received factor Xa inhibitors (50.8%), or warfarin (39.8%). The crude rate of in-hospital mortality was 10.9% and 30-day mortality was 13.9% (Table 1). In-hospital mortality was highest after intracranial (38.3%) followed by gastrointestinal bleeding (5.6%). Individuals with intracranial bleeding had the highest rates of ICU admission (34.9%) and long-term care (19.9%). Compared to genitourinary bleeding, intracranial bleeding was associated with the highest risk of in-hospital mortality (HR 77.38, 95%CI 31.03-192.98) followed by gastrointestinal bleeding (HR 7.11, 95%CI 2.84-17.81) (Table 2). Increasing age, female sex, long-term care residence, cancer, and Elixhauser comorbidity index ≥4 were also associated with higher mortality.

Conclusion(s): Older individuals hospitalized for OAC-related bleeding experience high mortality during hospitalization. While index bleed site was the most important factor associated with mortality, patient characteristics contribute to risk and may aid counselling and inform prevention strategies.