Impact of diagnostic coding schemas on major bleeding risk assessment for oral anticoagulants in patients with atrial fibrillation using administrative claims data.

IF 5.5 2区 医学 Q1 HEMATOLOGY
Hsiu-Ting Chien, Tze-Fan Chao, Rosa Wang, Chia-Jui Chang, Shin-Yi Lin, Fang-Ju Lin
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引用次数: 0

Abstract

Introduction: This study evaluated how different published diagnostic coding schemas impact the assessment of major bleeding risks associated with direct oral anticoagulants (DOACs) and warfarin.

Methods: This retrospective cohort study included patients with atrial fibrillation who initiated DOACs or warfarin between 2012 and 2019, using Taiwan's national claims database. Major bleeding events, including gastrointestinal bleeding (GIB), intracranial hemorrhage (ICH), and other major bleeding events, were identified using coding schemas from Cunningham et al, the Mini-Sentinel protocol, and Yao et al. Propensity score matching was performed to ensure covariate balance. Incidence rates and hazard ratios (HRs) were estimated to evaluate the bleeding risks.

Results: After matching, each cohort comprised 20,704 patients. The number of reported major bleeding events was influenced by the strictness of the coding schema, with Cunningham's yielding the most events, followed by the Mini-Sentinel and Yao's schemas. DOACs were associated with a consistently lower risk of composite major bleeding (HR range across different coding schemas: 0.73-0.76, all P<0.05) and ICH (HR range: 0.43-0.63, all P<0.05) but not GIB (HR range: 0.87-0.90, all P>0.05), regardless of the coding schema applied. Restricting ICH definitions to primary diagnosis or spontaneous cases revealed a more pronounced reduction in ICH risk associated with DOACs.

Conclusions: While the choice of coding schemas has a negligible impact on overall bleeding risk comparisons between DOACs and warfarin, it significantly affects ICH risk assessment. This underscores the importance of careful coding schema selection in observational studies evaluating major bleeding risks.

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来源期刊
Journal of Thrombosis and Haemostasis
Journal of Thrombosis and Haemostasis 医学-外周血管病
CiteScore
24.30
自引率
3.80%
发文量
321
审稿时长
1 months
期刊介绍: The Journal of Thrombosis and Haemostasis (JTH) serves as the official journal of the International Society on Thrombosis and Haemostasis. It is dedicated to advancing science related to thrombosis, bleeding disorders, and vascular biology through the dissemination and exchange of information and ideas within the global research community. Types of Publications: The journal publishes a variety of content, including: Original research reports State-of-the-art reviews Brief reports Case reports Invited commentaries on publications in the Journal Forum articles Correspondence Announcements Scope of Contributions: Editors invite contributions from both fundamental and clinical domains. These include: Basic manuscripts on blood coagulation and fibrinolysis Studies on proteins and reactions related to thrombosis and haemostasis Research on blood platelets and their interactions with other biological systems, such as the vessel wall, blood cells, and invading organisms Clinical manuscripts covering various topics including venous thrombosis, arterial disease, hemophilia, bleeding disorders, and platelet diseases Clinical manuscripts may encompass etiology, diagnostics, prognosis, prevention, and treatment strategies.
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