Increasing use of anticoagulants in Germany and its impact on hospitalization for gastrointestinal bleeding
The aim of the study was to compare nationwide time trends of oral anticoagulant prescriptions with the time trend of gastrointestinal bleeding (GIB) in Germany from 2005 through 2016. The annual number of hospital admissions for GIB associated with gastric ulcers, duodenal ulcers, hematemesis, mele...
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| Veröffentlicht in: | Thrombosis research 2019-09, Vol.181, p.135-140 |
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| creator | Guelker, Jan-Erik Ilousis, Dimitrios Kröger, Knut Santosa, Frans Kowall, Bernd Stang, Andreas |
| description | The aim of the study was to compare nationwide time trends of oral anticoagulant prescriptions with the time trend of gastrointestinal bleeding (GIB) in Germany from 2005 through 2016.
The annual number of hospital admissions for GIB associated with gastric ulcers, duodenal ulcers, hematemesis, melena, hematochezia, and unspecified gastrointestinal bleeding (USGIH) was taken from the nationwide hospital referral file by the Federal Bureau of Statistics. The hospitalization rates were age-standardized using the German Standard Population 2011. The defined daily doses (DDD) of prescribed anticoagulants in outpatients for the same calendar period were taken from reports of the drug information system of the statutory health insurance. Based on DDD, drug treatment rates were calculated per 100,000 people.
From 2005 to 2016, the annual anticoagulant prescription rates per 100,000 persons increased by 135.8% (from 901.4 to 2125.9). By 2011, direct oral anticoagulants (DOAC) accounted for |
| doi_str_mv | 10.1016/j.thromres.2019.07.009 |
| format | Article |
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The annual number of hospital admissions for GIB associated with gastric ulcers, duodenal ulcers, hematemesis, melena, hematochezia, and unspecified gastrointestinal bleeding (USGIH) was taken from the nationwide hospital referral file by the Federal Bureau of Statistics. The hospitalization rates were age-standardized using the German Standard Population 2011. The defined daily doses (DDD) of prescribed anticoagulants in outpatients for the same calendar period were taken from reports of the drug information system of the statutory health insurance. Based on DDD, drug treatment rates were calculated per 100,000 people.
From 2005 to 2016, the annual anticoagulant prescription rates per 100,000 persons increased by 135.8% (from 901.4 to 2125.9). By 2011, direct oral anticoagulants (DOAC) accounted for <0.1% of all anticoagulants, but 49.9% in 2016. Over the same period, age-standardized hospital admissions for GIBs per 100,000 person-years decreased by 14% (from 128.89 to 110.87). Hospitalization rates for gastric ulcer and duodenal ulcer decreased steadily, and those for hematoma, melena and hematochezia continued to increase. Only the USGIH decreased from 2005 to 2011 (annual change of −3.35 (95% CI −5.44; −1.25) per 100,000 person-years) and subsequently increased (0.61, 95% CI −0,42; 1.65). Of all GIB cases, 5.8% received at least 6 red blood cell concentrates in 2005 and 4.6% in 2016. The two-phase time trend for USGIH was no longer present in this subgroup.
Our nationwide comparison of outpatient OAC treatment rates and hospitalization rates for GIBs showed that GIB hospitalization rates declined despite increasing OAC treatment rates from 2005 to 2016. With increasing impact of DOACs after 2011, this decline was not affected.
•We compared nationwide time trends of oral anticoagulant prescriptions with gastrointestinal bleeding (GIB) in Germany.•From 2005 to 2016, the annual anticoagulant prescription rates per 100,000 persons in Germany increased by 135.8% (from 901.4 to 2125.9).•Despite such an increase and a shift towards DOAC, hospitalizations for GIBs decreased by 14% during this period•Hospital admission for severe GIB decreased from 5.8% of GIB cases in 2005 to 4.6% in 2016.</description><identifier>ISSN: 0049-3848</identifier><identifier>EISSN: 1879-2472</identifier><identifier>DOI: 10.1016/j.thromres.2019.07.009</identifier><identifier>PMID: 31415939</identifier><language>eng</language><publisher>United States: Elsevier Ltd</publisher><subject>Anticoagulants - pharmacology ; Anticoagulants - therapeutic use ; Direct oral anticoagulants ; Female ; Gastrointestinal bleedings ; Gastrointestinal Diseases - drug therapy ; Germany ; Hemorrhage ; Humans ; Male ; Vitamin K antagonists</subject><ispartof>Thrombosis research, 2019-09, Vol.181, p.135-140</ispartof><rights>2019</rights><rights>Copyright © 2019. Published by Elsevier Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c368t-8bb470eea928e92889f2e15a9d61b289ded6a79f48777e58991f95ac518dc6c53</citedby><cites>FETCH-LOGICAL-c368t-8bb470eea928e92889f2e15a9d61b289ded6a79f48777e58991f95ac518dc6c53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0049384819302920$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31415939$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Guelker, Jan-Erik</creatorcontrib><creatorcontrib>Ilousis, Dimitrios</creatorcontrib><creatorcontrib>Kröger, Knut</creatorcontrib><creatorcontrib>Santosa, Frans</creatorcontrib><creatorcontrib>Kowall, Bernd</creatorcontrib><creatorcontrib>Stang, Andreas</creatorcontrib><title>Increasing use of anticoagulants in Germany and its impact on hospitalization for gastrointestinal bleeding</title><title>Thrombosis research</title><addtitle>Thromb Res</addtitle><description>The aim of the study was to compare nationwide time trends of oral anticoagulant prescriptions with the time trend of gastrointestinal bleeding (GIB) in Germany from 2005 through 2016.
The annual number of hospital admissions for GIB associated with gastric ulcers, duodenal ulcers, hematemesis, melena, hematochezia, and unspecified gastrointestinal bleeding (USGIH) was taken from the nationwide hospital referral file by the Federal Bureau of Statistics. The hospitalization rates were age-standardized using the German Standard Population 2011. The defined daily doses (DDD) of prescribed anticoagulants in outpatients for the same calendar period were taken from reports of the drug information system of the statutory health insurance. Based on DDD, drug treatment rates were calculated per 100,000 people.
From 2005 to 2016, the annual anticoagulant prescription rates per 100,000 persons increased by 135.8% (from 901.4 to 2125.9). By 2011, direct oral anticoagulants (DOAC) accounted for <0.1% of all anticoagulants, but 49.9% in 2016. Over the same period, age-standardized hospital admissions for GIBs per 100,000 person-years decreased by 14% (from 128.89 to 110.87). Hospitalization rates for gastric ulcer and duodenal ulcer decreased steadily, and those for hematoma, melena and hematochezia continued to increase. Only the USGIH decreased from 2005 to 2011 (annual change of −3.35 (95% CI −5.44; −1.25) per 100,000 person-years) and subsequently increased (0.61, 95% CI −0,42; 1.65). Of all GIB cases, 5.8% received at least 6 red blood cell concentrates in 2005 and 4.6% in 2016. The two-phase time trend for USGIH was no longer present in this subgroup.
Our nationwide comparison of outpatient OAC treatment rates and hospitalization rates for GIBs showed that GIB hospitalization rates declined despite increasing OAC treatment rates from 2005 to 2016. With increasing impact of DOACs after 2011, this decline was not affected.
•We compared nationwide time trends of oral anticoagulant prescriptions with gastrointestinal bleeding (GIB) in Germany.•From 2005 to 2016, the annual anticoagulant prescription rates per 100,000 persons in Germany increased by 135.8% (from 901.4 to 2125.9).•Despite such an increase and a shift towards DOAC, hospitalizations for GIBs decreased by 14% during this period•Hospital admission for severe GIB decreased from 5.8% of GIB cases in 2005 to 4.6% in 2016.</description><subject>Anticoagulants - pharmacology</subject><subject>Anticoagulants - therapeutic use</subject><subject>Direct oral anticoagulants</subject><subject>Female</subject><subject>Gastrointestinal bleedings</subject><subject>Gastrointestinal Diseases - drug therapy</subject><subject>Germany</subject><subject>Hemorrhage</subject><subject>Humans</subject><subject>Male</subject><subject>Vitamin K antagonists</subject><issn>0049-3848</issn><issn>1879-2472</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkMFu3CAQhlHUKtmkfYWIYy92ABsDt0RRm660Ui7pGWE83rC1YQu4UvL0ZbW7veYwYgb-mZ_5ELqlpKaEdne7Or_GMEdINSNU1UTUhKgLtKJSqIq1gn1CK0JaVTWylVfoOqUdIVRQxS_RVUNbylWjVuj32tsIJjm_xUsCHEZsfHY2mO0ylSxh5_ETxNn4t_IyYHe4mvfGZhw8fg1p77KZ3LvJrtRjiHhrUo7B-QwpO28m3E8AQzH4gj6PZkrw9XTeoF8_vr88_qw2z0_rx4dNZZtO5kr2fSsIgFFMQgmpRgaUGzV0tGdSDTB0RqixlUII4FIpOipuLKdysJ3lzQ36dpy7j-HPUn6hZ5csTGUfCEvSjAneMEE4KdLuKLUxpBRh1PvoZhPfNCX6AFrv9Bm0PoDWROgCujTenjyWfobhf9uZbBHcHwVQNv3rIOpkHXhbSESwWQ_BfeTxDx4zlUo</recordid><startdate>201909</startdate><enddate>201909</enddate><creator>Guelker, Jan-Erik</creator><creator>Ilousis, Dimitrios</creator><creator>Kröger, Knut</creator><creator>Santosa, Frans</creator><creator>Kowall, Bernd</creator><creator>Stang, Andreas</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201909</creationdate><title>Increasing use of anticoagulants in Germany and its impact on hospitalization for gastrointestinal bleeding</title><author>Guelker, Jan-Erik ; Ilousis, Dimitrios ; Kröger, Knut ; Santosa, Frans ; Kowall, Bernd ; Stang, Andreas</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c368t-8bb470eea928e92889f2e15a9d61b289ded6a79f48777e58991f95ac518dc6c53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Anticoagulants - pharmacology</topic><topic>Anticoagulants - therapeutic use</topic><topic>Direct oral anticoagulants</topic><topic>Female</topic><topic>Gastrointestinal bleedings</topic><topic>Gastrointestinal Diseases - drug therapy</topic><topic>Germany</topic><topic>Hemorrhage</topic><topic>Humans</topic><topic>Male</topic><topic>Vitamin K antagonists</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Guelker, Jan-Erik</creatorcontrib><creatorcontrib>Ilousis, Dimitrios</creatorcontrib><creatorcontrib>Kröger, Knut</creatorcontrib><creatorcontrib>Santosa, Frans</creatorcontrib><creatorcontrib>Kowall, Bernd</creatorcontrib><creatorcontrib>Stang, Andreas</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Thrombosis research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Guelker, Jan-Erik</au><au>Ilousis, Dimitrios</au><au>Kröger, Knut</au><au>Santosa, Frans</au><au>Kowall, Bernd</au><au>Stang, Andreas</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Increasing use of anticoagulants in Germany and its impact on hospitalization for gastrointestinal bleeding</atitle><jtitle>Thrombosis research</jtitle><addtitle>Thromb Res</addtitle><date>2019-09</date><risdate>2019</risdate><volume>181</volume><spage>135</spage><epage>140</epage><pages>135-140</pages><issn>0049-3848</issn><eissn>1879-2472</eissn><abstract>The aim of the study was to compare nationwide time trends of oral anticoagulant prescriptions with the time trend of gastrointestinal bleeding (GIB) in Germany from 2005 through 2016.
The annual number of hospital admissions for GIB associated with gastric ulcers, duodenal ulcers, hematemesis, melena, hematochezia, and unspecified gastrointestinal bleeding (USGIH) was taken from the nationwide hospital referral file by the Federal Bureau of Statistics. The hospitalization rates were age-standardized using the German Standard Population 2011. The defined daily doses (DDD) of prescribed anticoagulants in outpatients for the same calendar period were taken from reports of the drug information system of the statutory health insurance. Based on DDD, drug treatment rates were calculated per 100,000 people.
From 2005 to 2016, the annual anticoagulant prescription rates per 100,000 persons increased by 135.8% (from 901.4 to 2125.9). By 2011, direct oral anticoagulants (DOAC) accounted for <0.1% of all anticoagulants, but 49.9% in 2016. Over the same period, age-standardized hospital admissions for GIBs per 100,000 person-years decreased by 14% (from 128.89 to 110.87). Hospitalization rates for gastric ulcer and duodenal ulcer decreased steadily, and those for hematoma, melena and hematochezia continued to increase. Only the USGIH decreased from 2005 to 2011 (annual change of −3.35 (95% CI −5.44; −1.25) per 100,000 person-years) and subsequently increased (0.61, 95% CI −0,42; 1.65). Of all GIB cases, 5.8% received at least 6 red blood cell concentrates in 2005 and 4.6% in 2016. The two-phase time trend for USGIH was no longer present in this subgroup.
Our nationwide comparison of outpatient OAC treatment rates and hospitalization rates for GIBs showed that GIB hospitalization rates declined despite increasing OAC treatment rates from 2005 to 2016. With increasing impact of DOACs after 2011, this decline was not affected.
•We compared nationwide time trends of oral anticoagulant prescriptions with gastrointestinal bleeding (GIB) in Germany.•From 2005 to 2016, the annual anticoagulant prescription rates per 100,000 persons in Germany increased by 135.8% (from 901.4 to 2125.9).•Despite such an increase and a shift towards DOAC, hospitalizations for GIBs decreased by 14% during this period•Hospital admission for severe GIB decreased from 5.8% of GIB cases in 2005 to 4.6% in 2016.</abstract><cop>United States</cop><pub>Elsevier Ltd</pub><pmid>31415939</pmid><doi>10.1016/j.thromres.2019.07.009</doi><tpages>6</tpages></addata></record> |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Anticoagulants - pharmacology Anticoagulants - therapeutic use Direct oral anticoagulants Female Gastrointestinal bleedings Gastrointestinal Diseases - drug therapy Germany Hemorrhage Humans Male Vitamin K antagonists |
| title | Increasing use of anticoagulants in Germany and its impact on hospitalization for gastrointestinal bleeding |
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