Effects of anticoagulation therapy with vitamin K antagonists on hospitalizations and emergency room accesses in Grosseto (Italy).

Introduction: A lot of drug groups are associated with preventable drug-related admissions. Coumarin derivatives, prescribed for the treatment and prevention of deep vein thrombosis or pulmonary embolism or prevention of systemic embolism or stroke in patients with prosthetic heart valves or atrial fibrillation, are often associated with bleeding. The aim of our study was to analyze how the anticoagulant therapy with VKAs could affects the hospitalizations and the visits to emergency room in the elderly population (> 65 years old).

Methods: In 2013 we conducted a cross sectional study analyzing the database of all pharmaceutical prescriptions, selecting patients living in Grosseto (Italy), which received at least two prescriptions of coumarin derivatives in 2012. We analyzed the admissions to hospital and the accesses to the emergency rooms (ERs) made by each patient, focusing especially on those related to bleeding. For each access to ER we recorded the date, time of stay, diagnosis and outcome. For each hospitalization the information we recorded were the date of admission and discharge diagnosis.

Results: 3684 patients were included in our study. 261 (7.1%) patients visited the emergency room for bleeding; 37 (1%) for intracranial bleeding. The accesses made by men were higher than those made by women. The average time of stay in ER was 349 minutes. The admissions to hospital were 96 (2.6%); 42 (1.1%) were admitted to hospital with a diagnosis of major vascular event. 53 patients (20.3%), accessed to the ER more than one time. The 11.5% was admitted to the hospital more than one time.

Conclusions: Our study showed that VKAs are responsible of an increase of the accesses to ER and of the admissions to hospital. However, it would be interesting to enlarge the sample size including patients living in other provinces or in other regions, with a lower age and treated also with TSOACs, in order to evaluate the real cost-effectiveness of anticoagulant therapy.