Abstract 15171: Contemporary Rates and Predictors of Thromboembolic Events in Adults After Treatment With Plasma for Warfarin-Related Bleeding: The REVERSAL Study
Introduction: Serious bleeding in patients receiving warfarin is frequently treated with plasma for rapid reversal of anticoagulation. Few contemporary data exist about the short-term risk and predictors of subsequent thromboembolic events after treatment with plasma.
Methods: Within Kaiser Permanente Northern & Southern California, two integrated healthcare delivery systems caring for >7.6 million members, we conducted a retrospective study of all adults who received plasma for rapid warfarin reversal for major bleeding during 2008-2013. We identified thromboembolic events (TEE) during the first 45 days after receipt of plasma based on comprehensive health plan databases, with physician adjudication of medical records. Data on patient demographics, comorbidities and baseline medication use were ascertained from health plan administrative, inpatient and outpatient diagnosis and procedure, laboratory and pharmacy databases. We used multivariable logistic regression to identify independent predictors of TEEs.
Results: In 4679 adults hospitalized for warfarin-related major bleeding who received plasma for rapid warfarin reversal, mean age was 75±11 years, with 56% women, 11% black, 12% Asian and 15% Hispanic. Thirty-nine percent of bleeds were intracranial, 57% gastrointestinal and 4% were other major extracranial bleeds. There was a high prevalence of pre-existing morbidity, including 42% heart failure, 87% hypertension, 38% diabetes, 84% dyslipidemia and 38% chronic lung disease. During the first 45 days after receipt of plasma, 3.6% (95% CI: 3.1-4.2%) of patients had a confirmed TEE. Multivariable predictors of TEE included BMI <18.5 kg/m2 (OR 3.22 vs. BMI 18.5-24.9 kg/m2, 1.54-6.71), prior TEE within 90 days (OR 2.46, 1.20-5.01), intracranial bleed (OR 1.59 vs. GI bleed, 1.12-2.26), vitamin K 5.1-10 mg (OR 1.86 vs. ≤5 mg, 1.04-3.33) and former smoking (OR 0.61 vs. never smoking, 0.43-0.87).
Conclusions: In a large, diverse contemporary population of adults receiving plasma for rapid warfarin reversal for major bleeding, 1 in 28 patients experienced a TEE in the first 45 days. Intracranial bleed, prior TEE within 90 days of index bleed, low BMI and never smoking status can identify patients at higher short-term risk for subsequent TEE.
Author Disclosures: A.S. Go: Research Grant; Significant; CSL Behring. T.K. Leong: None. U.M. Forssen: Employment; Significant; CSL Behring. D.J. Watson: Employment; Significant; CSL Behring. S. Sung: None. T.N. Harrison: None. K. Reynolds: Research Grant; Significant; CSL Behring.
- © 2016 by American Heart Association, Inc.