IRON-DEFICIENCY ANEMIA IN PATIENTS RECEIVING ORAL ANTICOAGULANTS

Abstract

During the previous two decades, novel oral anticoagulants (NOACs) (dabigatran, rivaroxaban, epicasaban, etc.) have been introduced into clinical practice. In a number of studies they proved better efficacy than warfarin. At the same time, finding the optimal balance between the achievement of a clinically effective level of anticoagulation while maintaining a low risk of bleeding is a difficult task in clinical practice. Long-term administration of NOACs in elderly patients having comorbid pathology (peptic ulcer of the stomach and / or duodenal ulcer, varicose veins of the esophagus, prostate pathology, etc.) can provoke recurring small bleeding, which often does not attract enough attention of the patient, remains unrecognized for a long time, but eventually leads to the development of iron deficiency and even anemia. The purpose of the study: to determine the prevalence of iron deficiency and iron deficiency anemia in patients undergoing long-term NOACs treatment, to analyze the most common origins of bleeding, to assess the rationality of the prescribed treatment. 78 patients who received treatment with warfarin, rivaroxaban or acenocoumarol were enrolled to the study. Indications for long-term treatment with NOACs were: in 65 patients - a permanent form of atrial fibrillation, 13 - post-cardiac surgery indications. The average age was 64,323,27 years. Men were represented by a younger agegroup (57,122,8 years) compared to women (67,354,4 years; p?0,05). The average time of treatment with NOACs PAK was 16,72,1 months. Episodes of bleeding were noted in 13 patients, in almost half of the cases in the form of epistahis. During the analyzed period of NOACs treatment, the laboratory criteria for anemia was noted in 11 patients, while 3 had decreased ferritin concentration <30 ng/ml. It is noteworthy that only 4 of them had documented at least one case of bleeding. By re-examination of anemic patients was found that 5 of them suffered on gum bleeding in the course of brushing the teeth, 3 of them had recurrent microscopic hematuria due to the pathology of the prostate gland and 2 of them had petechial hemorrhages on the skin. Among 11 patients who had symptoms of anemia, only 3 received iron-medication, only 2 had evaluated hemoglobin and ferritin concentration in blood in the following. Concluded that iron deficiency syndrome and anemia are wide-spread among patients receiving treatment with NOACs, possibly, as a consequence of undiagnosed small bleeding events. As patients dont pay enough attention for this bleedings, iron deficiency syndrome remains undiagnosed and patients arent receive adequate treatment.

Keywords

• oral anticoagulants
• iron deficiency anemia
• atrial fibrillation
• treatment
• iron-containing drugs