Resource Utilisation And Bleeding Events During Anticoagulation Treatment: Real-World Findings From England

Abstract

Over one million UK patients suffer from non-valvular atrial fibrillation (NVAF), which can lead to stroke and arterial embolism. Vitamin K antagonists (VKA), usually warfarin, are the most frequently-prescribed anticoagulants in the UK. This study aimed to estimate the association between healthcare resource use and subsequent bleeding in NVAF patients prescribed VKA in England. A retrospective cohort analysis of primary care data from the UK Clinical Practice Research Datalink (CPRD), linked to secondary care data from the Hospital Episode Statistics (HES) database, identified patients with NVAF who were prescribed a VKA. Bleeding events were identified (any bleeds [AB] as a composite of major bleed [MB] + clinically-relevant non-major bleeds [CRNMB]). Resources utilised by patients (GP consultations, total prescriptions, hospitalisations) were estimated. To compare resource utilization in time after bleeding events versus time with no bleeding events, we used log-Poisson generalized linear models with robust variances to calculate incidence rate ratios (IRR) and 95% CIs adjusted on baseline patient characteristics. A cohort of 29,489 NVAF patients newly-treated with VKA were identified, with mean age of 73.4 years, 57.8% male, mean BMI 29.1, mean CHA2DS2-VASC 2.7, and mean HAS-BLED 2.0. Of these patients, 14.6% had experienced a prior bleeding event. Each month there were a mean 2.6 GP consultations, 0.1 hospitalizations, and 7 prescriptions per patient. We observed an increased risk of overall prescriptions following a 1st bleed (IRR 1.12; 1.09-1.16), 2nd bleed (1.18; 1.12-1.24) and 3rdbleed (1.25; 1.16-1.36) compared to follow-up time without any bleed. Similar results were observed for GP consultations and hospitalizations (despite absence of a linear pattern). In NVAF patients treated with VKA, the first and subsequent bleeds led to an increased risk of healthcare resource utilisation. Healthcare payers, as well as patients and clinicians, would therefore benefit from clinical strategies to help prevent the first bleed.