Examining The Influence of Social Determinants on Bleeding Outcomes in Anticoagulation Therapy: A Scoping Review

Yıl 2024, Cilt: 3 Sayı: 2, 22 - 39, 01.09.2024

Aykut Turgut , Ümmühan Yiğit , Ganime Esra Soysal , Arzu Özcan İlçe

Öz

Background
Oral anticoagulation (OAC) control reduces the likelihood of unwanted bleeding and delays the patient's blood clotting. Differences in prescription patterns and bleeding events of oral anticoagulants have already been observed concerning social determinants, such as socioeconomic status, gender, age, race/ethnicity, alcohol use, etc.
Purpose
The objective of the study is to examine the effect of social determinants on bleeding in patients using oral anticoagulants.
Conclusions
Low socioeconomic status is a significant determinant in bleeding-related deaths among these patients. Low-income individuals and black patients are less likely to access oral anticoagulant therapy. Older age is a crucial social determinant of bleeding with anticoagulant therapy, and the bleeding risk rises with advancing age. Although the gender variable did not have a significant effect in terms of International Normalized Ratio (INR) control and bleeding risk. General alcohol use is not a social determinant in determining the risk of bleeding. However, the heavy alcohol use and socioeconomic status of the patients should be assessed in determining the risk of bleeding.
Clinical implications
Ethnicity and socioeconomic status are important parameters in the management of patient care by healthcare professionals and in evaluating the risk of bleeding in patients using anticoagulant therapy. Patient history should be carefully evaluated by nurses and more frequent INR monitoring should be done in these patients. The literature indicates that more research is needed to understand underlying factors and develop strategies to address disparities in the use of oral anticoagulant therapy among patients of especially different racial and alcohol social determinants.

Anahtar Kelimeler

Anticoagulant, Bleeding, Gender, Thrombosis, Ethnicity

Antikoagülasyon Tedavisinde Sosyal Belirleyicilerin Kanama Sonuçları Üzerindeki Etkisinin İncelenmesi: Kapsam İncelemesi

Öz

Giriş
Oral antikoagülasyon (OAK) kontrolü, istenmeyen kanama olasılığını azaltır ve hastanın kanının pıhtılaşmasını geciktirir. Sosyal belirleyiciler, örneğin sosyoekonomik durum, cinsiyet, yaş, ırk/etnik köken, alkol kullanımı gibi faktörler ile oral antikoagülanların reçetelenme alışkanlıkları ve kanama olaylarında farklılıklar gözlemlenmiştir.
Amaç
Çalışmanın amacı, oral antikoagülan kullanan hastalarda sosyal belirleyicilerin kanama üzerindeki etkisini incelemektir.
Sonuç
Düşük sosyoekonomik durum, bu hastalar arasında kanamaya bağlı ölümlerde önemli bir belirleyicidir. Düşük gelirli bireylerin ve siyahi hastaların oral antikoagülan tedaviye erişme olasılığı daha düşüktür. İleri yaş, antikoagülan tedavide kanama riskinin önemli bir sosyal belirleyicisidir ve yaş ilerledikçe kanama riski artar. Cinsiyet değişkeninin, Uluslararası Normalleştirilmiş Oran (INR) kontrolü ve kanama riski açısından anlamlı bir etkisi olmamıştır. Genel alkol kullanımı kanama riskini belirlemede sosyal bir belirleyici olarak görülmemektedir. Ancak kanama riskinin belirlenmesinde hastaların ağır alkol kullanımı ve sosyoekonomik durumları değerlendirilmelidir.
Klinik çıkarımlar
Etnik köken ve sosyoekonomik durum, sağlık profesyonelleri tarafından hasta bakımının yönetilmesinde ve antikoagülan tedavi kullanan hastalarda kanama riskinin değerlendirilmesinde önemli parametrelerdir. Hemşireler, hasta öyküsünü dikkatlice değerlendirmeli ve bu hastalarda daha sık INR izlemesi yapılmalıdır. Literatür, özellikle farklı ırk ve alkol gibi sosyal belirleyicileri olan hastalar arasında oral antikoagülan tedavisindeki eşitsizlikleri ele almak için daha fazla araştırma yapılması gerektiğini belirtmektedir.

Anahtar Kelimeler

Antikoagülan, Kanama, Cinsiyet, Tromboz, Etnisite

Kaynakça

• Addo, J., Ayerbe, L., Mohan, K. M., Crichton, S., Sheldenkar, A., Chen, R., Wolfe, C. D. A., & McKevitt, C. (2012). Socioeconomic status and stroke: An updated review. Stroke, 43(4), 1186–1191. https://doi.org/10.1161/STROKEAHA.111.639732
• Adler, N. E., Boyce, T., Chesney, M. A., Cohen, S., Folkman, S., Kahn, R. L., & Syme, S. L. (1994). Socioeconomic status and health: The challenge of the gradient. American Psychologist, 49(1), 15–24. https://doi.org/https://doi.org/10.1037/0003-066X.49.1.15
• Adrianzen-Herrera, D., Giorgio, K., Walker, R. F., Sparks, A. D., Gergi, M., Zakai, N. A., & Lutsey, P. L. (2024). Bleeding risk from anticoagulant thromboprophylaxis in patients with multiple myeloma: a MarketScan analysis. Research and Practice in Thrombosis and Haemostasis, 8(4). https://doi.org/10.1016/j.rpth.2024.102418
• Arksey, H., Malley, L. O., Arksey, H., & Malley, L. O. (2007). Scoping studies : towards a methodological framework Scoping Studies : Towards a Methodological Framework. 5579. https://doi.org/10.1080/1364557032000119616
• Bozic, D., Vukovic, J., Mustapic, I., Cindro, P. V., Bozic, J., Kardum, G., Puljiz, Z., Hadjina, I. T., & Tonkic, A. (2021). Characteristics and clinical outcomes of patients with acute gastrointestinal bleeding related to anticoagulant or antiplatelet therapy: A retrospective study. Croatian Medical Journal, 62(5), 488–494. https://doi.org/10.3325/cmj.2021.62.488
• Büchele, K., Rapp, G., Jaensch, J. M. B. A., & Petra, C. B. (2020). Risk of traumatic intracranial haemorrhage is increased in older people exposed to oral anticoagulation with phenprocoumon. Aging Clinical and Experimental Research, 32(3), 441–447. https://doi.org/10.1007/s40520-019-01215-5
• Carnicelli, A., Hong, H., Connolly, S. J., Eikelboom, J., Giugliano, R. P., Morrow, D. A., Patel, M. R., Wallentin, L., Alexander, J. H., Cecilia Bahit, M., Benz, A. P., Bohula, E. A., Chao, T.-F., Dyal, L., Ezekowitz, M., A.A. Fox, K., Gencer, B., Halperin, J. L., Hijazi, Z., … Granger, C. B. (2022). Direct Oral Anticoagulants Versus Warfarin in Patients With Atrial Fibrillation: Patient-Level Network Meta-Analyses of Randomized Clinical Trials With Interaction Testing by Age and Sex. Circulation, 145(4), 242–255. https://doi.org/10.1161/circulationaha.121.056355
• Cressman, A. M., MacDonald, E. M., Yao, Z., Austin, P. C., Gomes, T., Paterson, J. M., Kapral, M. K., Mamdani, M. M., & Juurlink, D. N. (2015). Socioeconomic status and risk of hemorrhage during warfarin therapy for atrial fibrillation: A population-based study. American Heart Journal, 170(1), 133-140.e3. https://doi.org/10.1016/j.ahj.2015.03.014
• Dagres, N., Nieuwlaat, R., Vardas, P. E., Andresen, D., Lévy, S., Cobbe, S., Kremastinos, D. T., Breithardt, G., Cokkinos, D. V., Crijns, H. J. G. M., Camm, A. J., Davies, W., Capucci, A., Olsson, B., Aliot, E., Le Heuzey, J. Y., Santini, M., Manini, M., Bramley, C., … Randjelovic, M. (2007). Gender-Related Differences in Presentation, Treatment, and Outcome of Patients With Atrial Fibrillation in Europe. A Report From the Euro Heart Survey on Atrial Fibrillation. Journal of the American College of Cardiology, 49(5), 572–577. https://doi.org/10.1016/j.jacc.2006.10.047
• Dalén, M., Persson, M., Glaser, N., & Sartipy, U. (2022). Socioeconomic Status and Risk of Bleeding After Mechanical Aortic Valve Replacement. Journal of the American College of Cardiology, 79(25), 2502–2513. https://doi.org/10.1016/j.jacc.2022.04.030
• Domínguez-Erquicia, P., Raposeiras-Roubín, S., Abbu-Assi, E., Cespón-Fernández, M., Alonso-Rodríguez, D., Camacho-Freire, S. J., Cubelos-Fernández, N., López-Masjuán Ríos, Á., Melendo-Viu, M., & Íñiguez-Romo, A. (2021). Incidence, predictors of bleeding and prognosis of bleeding in anticoagulated nonagenarian patients with atrial fibrillation. International Journal of Cardiology, 327, 217–222. https://doi.org/10.1016/j.ijcard.2020.11.023
• Essien, U. R., Chiswell, K., Kaltenbach, L. A., Wang, T. Y., Fonarow, G. C., Thomas, K. L., Turakhia, M. P., Benjamin, E. J., Rodriguez, F., Fang, M. C., Magnani, J. W., Yancy, C. W., & Piccini, J. P. (2022). Association of Race and Ethnicity With Oral Anticoagulation and Associated Outcomes in Patients With Atrial Fibrillation. JAMA Cardiology, 7(12), 1207. https://doi.org/10.1001/jamacardio.2022.3704
• Essien, U. R., Kim, N., Hausmann, L. R. M., Mor, M. K., Good, C. B., Magnani, J. W., Litam, T. M. A., Gellad, W. F., & Fine, M. J. (2021). Disparities in Anticoagulant Therapy Initiation for Incident Atrial Fibrillation by Race/Ethnicity among Patients in the Veterans Health Administration System. JAMA Network Open, 4(7), 1–14. https://doi.org/10.1001/jamanetworkopen.2021.14234
• Essien, U. R., Magnani, J. W., Chen, N., Gellad, W. F., Fine, M. J., & Hernandez, I. (2020). Race/Ethnicity and Sex-Related Differences in Direct Oral Anticoagulant Initiation in Newly Diagnosed Atrial Fibrillation: A Retrospective Study of Medicare Data. Journal of the National Medical Association, 112(1), 103–108. https://doi.org/10.1016/j.jnma.2019.10.003
• Gage, B. F., Birman-Deych, E., Kerzner, R., Radford, M. J., Nilasena, D. S., & Rich, M. W. (2005). Incidence of intracranial hemorrhage in patients with atrial fibrillation who are prone to fall. The American Journal of Medicine, 118(6), 612–617. https://doi.org/10.1016/j.amjmed.2005.02.022
• Haddad, A., Bocchese, M., Garber, R., O’Neill, B., Yesenosky, G. A., Patil, P., Keane, M. G., Islam, S., Sherrer, J. M., Basil, A., Gangireddy, C., Cooper, J. M., Cronin, E. M., & Whitman, I. R. (2021). Racial and ethnic differences in left atrial appendage occlusion wait time, complications, and periprocedural management. PACE - Pacing and Clinical Electrophysiology, 44(7), 1143–1150. https://doi.org/10.1111/pace.14255
• Hippisley-Cox, J. (2014). Predicting risk of upper gastrointestinal bleed and intracranial bleed with anticoagulants: Cohort study to derive and validate the QBleed scores. BMJ (Online), 349(July), 1–21. https://doi.org/10.1136/bmj.g4606
• Hu, A., Chow, C., Dao, D., Errett, L., & Mary Keith. (2006). of Warfarin Therapy After Mechanical Heart Valve Replacement. Journal of Cardiovascular Nursing, 21(3), 169–175.
• İlçe A., Yiğit, Ü., Soysal, G.E. (2022). Determination of Drug-Related Risk Behaviours of Patients Using Oral Anticoagulants and Innovative Solutions. Journal of Health Care and Rehabilitation, 1(1), 1-11.
• Kefale, A. T., Bezabhe, W. M., & Peterson, G. M. (2023). Oral Anticoagulant Use in Patients with Atrial Fibrillation at Low Risk of Stroke and Associated Bleeding Complications. Journal of Clinical Medicine, 12(19). https://doi.org/10.3390/jcm12196182
• Khatib, R., Glowacki, N., Byrne, J., & Brady, P. (2022). Impact of social determinants of health on anticoagulant use among patients with atrial fibrillation: Systemic review and meta-analysis. Medicine (United States), 101(35), E29997. https://doi.org/10.1097/MD.0000000000029997
• Kondo, N., Sembajwe, G., Kawachi, I., Van Dam, R. M., Subramanian, S. V., & Yamagata, Z. (2009). Income inequality, mortality, and self rated health: Meta-analysis of multilevel studies. BMJ (Online), 339(7731), 1178–1181. https://doi.org/10.1136/bmj.b4471
• Mackenbach, J. P., Bos, V., Andersen, O., Cardano, M., Costa, G., Harding, S., Reid, A., Hemström, Ö., Valkonen, T., & Kunst, A. E. (2003). Widening socioeconomic inequalities in mortality in six Western European countries. International Journal of Epidemiology, 32(5), 830–837. https://doi.org/10.1093/ije/dyg209
• Maguire, A., Douglas, I., Smeeth, L., & Thompson, M. (2007). Determinants of cholesterol and triglycerides recording in patients treated with lipid lowering therapy in UK primary care. Pharmacoepidemiol Drug Saf., 16(August), 228–228. https://doi.org/doi:10.1002/pds
• Manrique-Garcia, E., Sidorchuk, A., Hallqvist, J., & Moradi, T. (2011). Socioeconomic position and incidence of acute myocardial infarction: a meta-analysis. Journal of Epidemiology and Community Health, 65(4), 301 LP – 309. https://doi.org/10.1136/jech.2009.104075
• Matsumura, M., Sotomi, Y., Hirata, A., Sakata, Y., Hirayama, A., & Higuchi, Y. (2022). Sex-related difference in bleeding and thromboembolic risks in patients with atrial fibrillation treated with direct oral anticoagulants. Heart and Vessels, 37(3), 467–475. https://doi.org/10.1007/s00380-021-01931-x
• Nasser, S., Mullan, J., & Bajorek, B. (2012). Challenges of Older Patients’ Knowledge About Warfarin Therapy. Journal of Primary Care and Community Health, 3(1), 65–74. https://doi.org/10.1177/2150131911416365
• Nathan, A. S., Geng, Z., Dayoub, E. J., Khatana, S. A. M., Eberly, L. A., Kobayashi, T., Pugliese, S. C., Adusumalli, S., Giri, J., & Groeneveld, P. W. (2019). Racial, ethnic, and socioeconomic inequities in the prescription of direct oral anticoagulants in patients with venous thromboembolism in the United States. Circulation: Cardiovascular Quality and Outcomes, 12(4), 1–7. https://doi.org/10.1161/CIRCOUTCOMES.119.005600
• Nilsson, H., Grove, E. L., Larsen, T. B., Nielsen, P. B., Skjøth, F., Maegaard, M., & Christensen, T. D. (2014). Sex differences in treatment quality of self-managed oral anticoagulant therapy: 6,900 patient-years of follow-up. PLoS ONE, 9(11), 1–15. https://doi.org/10.1371/journal.pone.0113627
• Pham MT, Greig JD, Sargeant JM, Mcewen SA. A scoping review of scoping reviews: advancing the approach and enhancing the consistency. Res Synth Methods. 2015;(January 2014):71-385. doi:10.1002/jrsm.1123
• Peters, M., Godfrey, C., McInerney, P., Munn, Z., Tricco, A., & Khalil, H. (2020). Chapter 11: Scoping Reviews (2020 version). In E. Aromataris & Z. Munn (Eds.), JBI Manual for Evidence Synthesis.
• Pilcher, S. M., Alamneh, E. A., Chalmers, L., & Bereznicki, L. R. (2020). The Tasmanian Atrial Fibrillation Study (TAFS): Differences in Stroke Prevention According to Sex. Annals of Pharmacotherapy, 54(9), 837–845. https://doi.org/10.1177/1060028020904969
• Ravvaz, K., Weissert, J. A., Jahangir, A., & Ruff, C. T. (2021). Evaluating the effects of socioeconomic status on stroke and bleeding risk scores and clinical events in patients on oral anticoagulant for new onset atrial fibrillation. PLoS ONE, 16(3 March), 1–13. https://doi.org/10.1371/journal.pone.0248134
• Reddiess, P., Aeschbacher, S., Meyre, P., Coslovsky, M., Kühne, M., Rodondi, N., Baretella, O., Beer, J. H., Kobza, R., Moschovitis, G., Di Valentino, M., Müller, C., Steiner, F., Bonati, L. H., Sticherling, C., Osswald, S., & Conen, D. (2021). Alcohol consumption and risk of cardiovascular outcomes and bleeding in patients with established atrial fibrillation. Cmaj, 193(4), E117–E123. https://doi.org/10.1503/cmaj.200778
• Rohla, M., Weiss, T. W., Pecen, L., Patti, G., Siller-matula, J. M., Schnabel, R. B., Schilling, R., Kotecha, D., Lucerna, M., Huber, K., Caterina, R. De, & Kirchhof, P. (2019). Risk factors for thromboembolic and bleeding events in anticoagulated patients with atrial fibrillation : the prospective , multicentre observational PREvention oF thromboembolic events - European Registry in Atrial Fibrillation ( PREFER in AF ). BMJ, 1–8. https://doi.org/10.1136/bmjopen-2018-022478
• Roth, J. A., Bradley, K., Thumme, K. E., Veenstra, D. L., & Boudreau, D. (2018). Alcohol misuse, genetics, and major bleeding among warfarin therapy patients in a community setting. Physiology & Behavior, 176(1), 139–148. https://doi.org/10.1002/pds.3769
• Šinigoj, P., Vene, N., Košmelj, K., & Mavri, A. (2020). Risk of major bleeding in elderly patients with atrial fibrillation on direct oral anticoagulants: real world experience. International Journal of Clinical Pharmacy, 42(2), 445–452. https://doi.org/10.1007/s11096-020-01008-1
• Tamirisa, K. P., Dye, C., Ekeruo, I., & Volgman, A. S. (2022a). Atrial Fibrillation in Women: from Epidemiology to Treatment. Current Cardiovascular Risk Reports, 16(12), 207–217. https://doi.org/10.1007/s12170-022-00707-w
• Tedla, Y. G., Schwartz, S. M., Silberman, P., Greenland, P., & Passman, R. S. (2020). Racial Disparity in the Prescription of Anticoagulants and Risk of Stroke and Bleeding in Atrial Fibrillation Patients. Journal of Stroke and Cerebrovascular Diseases, 29(5), 104718. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104718
• Tricco, A. C., Lillie, E., Zarin, W., Brien, K. K. O., Colquhoun, H., Levac, D., Moher, D., Peters, M. D. J., Ma, Q., Horsley, T., Weeks, L., Hartling, L., Aldcroft, A., Hons, B. A., Wilson, M. G., & Garritty, C. (2018). R ESEARCH AND R EPORTING M ETHODS PRISMA Extension for Scoping Reviews ( PRISMA-ScR ): Checklist and Explanation. https://doi.org/10.7326/M18-0850
• Tse, W. C., Grey, C., Harwood, M., Jackson, R., Kerr, A., Mehta, S., Poppe, K., Pylypchuk, R., Wells, S., & Selak, V. (2021). Risk of major bleeding by ethnicity and socioeconomic deprivation among 488,107 people in primary care: a cohort study. BMC Cardiovascular Disorders, 21(1), 1–11. https://doi.org/10.1186/s12872-021-01993-9
• Vitry, A., Roughead, E. E., Ramsay, E. N., Preiss, A. K., Ryan, P., & Andrew L. Gilbert. (2007). Determinants of cholesterol and triglycerides recording in patients treated with lipid lowering therapy in UK primary care. Pharmacoepidemiology and Drug Safety, 16(August), 228–228. https://doi.org/10.1002/pds.2219