Presenting author: Dan Bloomfield, MD
Co-authors: B Alexander Yi, Karen Lipworth, Steve Burrows, Mellanie True Hills, Tarin Patrikis, Karen Pieper,
Marc P. Bonaca, John Glasspool
Anthos Therapeutics, Inc.; Insocius; StopAfib.org, American Foundation for Women’s Health;
National Blood Clot Alliance; Thrombosis Research Institute; CPC Clinical Research and University of
Colorado School of Medicine
Abstract ID: 1441167 Oral presentation: OC 21.4
Disclosures
I am an employee of and have a financial stake in Anthos Therapeutics [privately held company]
Learning Objectives
Understand the day-to-day bleeding problems (defined as bleeding not requiring medical intervention) experienced by patients on anticoagulants, and the impact on daily activities, emotional well-being, and adherence Review key results from a global survey on the impact of patient-relevant bleeding (PRB) events, including questions about their experiences, the effect on their emotions, and how it made them feel about their anticoagulant therapy.
The impact of bleeding events on quality of life for patients taking anticoagulation is not well studied
- Bleeding events or bruising that do not require medical
intervention are often referred to as “minor” bleeding
events, but even minor bleeds may be relevant to
patients - The term “minor” may also reduce HCP-patient
communication on this type of bleeding - We suggest using the term patient-relevant bleeding
(PRB) events instead of ‘minor’ bleeding - The impact of these PRB events among patients taking
anticoagulant medications is underreported, poorly
understood, and has not been well described
The objectives of this study were to explore the impact of PRB events in patients taking anticoagulants on:
- Daily activities
- Emotional well-being
- Adherence
Global survey of 3,000+ patients prescribed anticoagulants
Under the leadership of StopAfib.org and the National Blood Clot Alliance (NBCA), a
comprehensive patient questionnaire intended to gain quantitative and qualitative
insight on the impact of Patient-Relevant Bleeding (PRB) events, which we defined
as bleeding not requiring medical intervention.
Aims of Patient Survey: To explore the impact of PRB events on daily activities, emotional well-being, and adherence in patients taking anticoagulants
- Participants aged ≥21 years currently taking anticoagulants were included (warfarin, low molecular weight heparin, or direct oral anticoagulant)
- The online survey was made available in November 2022 and is accessible globally (English language only)
- No personally identifiable information collected
Bleeding problems reported across multiple diagnoses, with AF patients experiencing the highest rates
59% of patients reported experiencing a bleeding problem since starting an anticoagulant
47% of patients acknowledged bleeding may have an emotional impact
A substantial proportion of patients adjusted their lifestyles to reduce risk or hide bleeding
Bleeding problems often lead patients to want to pause treatment or reduce their anticoagulant dose
Conclusion: Patient impact is significant
Survey shows the impact of PRB events on patients’ quality-of-life
and adherence to anticoagulant therapy
- Patients withdraw from an active, healthy lifestyle to minimize bleeding risk
- Women stay at home during menstrual bleed due to fear of heavy periods
- Patient-reported emotional burden includes fear of a future bleed they are unable to control
- Without informing their HCP, some patients temporarily stop taking their anticoagulant medication
- Other studies suggest that consequences of poor adherence include a nearly 5X increased risk of thrombotic event but NO decrease in bleeding risk compared to fully adherent patients.
Instead of referring to these events as “minor”,
we propose the term “patient-relevant bleeding (PRB)”
to more appropriately reflect their impact and clinical significance
Clinical Significance
Need for a new generation of anticoagulants
In patients with atrial fibrillation being treated with an anticoagulant
- Major bleeds are critical, but ALL bleeds matter
- Bleeding and bruising that are relevant to patients, but may not require medical attention, should be considered relevant to the prognosis and clinical care of patients with atrial fibrillation
- Patient-relevant bleeding has a significant impact on the quality of life of patients and may lead to poor adherence, leaving patients at a high risk for experiencing a stroke
Acknowledgments
- Mellanie True Hills (StopAfib.org) and Tarin Patrikis (National Blood Clot Alliance) for facilitating the survey in their respective organizations, and the 3,000+ patients who took the time to complete the survey
- Karen Lipworth and Steve Burrows for the design of the questionnaire and analysis of the results