Leiden University Scholarly Publications

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Rein, N. van (2017)

Risk and prevention of bleeding during anticoagulant treatment

Doctoral Thesis
The overall goal of this thesis was to identify patients who are at high risk for major bleedings during anticoagulant treatment and to reduce the number of major bleeds. The first part looks into methodology of observational studies. It shows that biases in observational studies may be an explanation why statins seem to have many unintended effects. The second part looks into bleeding complications and shows that patient with three concomitant anticoagulants experience high major bleeding rates. Also, a study was performed in which plasma and DNA of participants was collected, to identify risk factors for major bleeds in the future. The first results show that damage to vessel walls increases the risk of major bleeding. Interventions to reduce the number of bleeding events were to dose nadroparin od instead of bid. In addition, multi-dose drug dispensing may increase adherence of medication. Also, vitamin K1 tablets are easier to ingest...Show more

The overall goal of this thesis was to identify patients who are at high risk for major bleedings during anticoagulant treatment and to reduce the number of major bleeds. The first part looks into methodology of observational studies. It shows that biases in observational studies may be an explanation why statins seem to have many unintended effects. The second part looks into bleeding complications and shows that patient with three concomitant anticoagulants experience high major bleeding rates. Also, a study was performed in which plasma and DNA of participants was collected, to identify risk factors for major bleeds in the future. The first results show that damage to vessel walls increases the risk of major bleeding. Interventions to reduce the number of bleeding events were to dose nadroparin od instead of bid. In addition, multi-dose drug dispensing may increase adherence of medication. Also, vitamin K1 tablets are easier to ingest and this thesis shows that the tablets are as effective in reducing the INR as the oral solution.

 

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Bleeding
Anticoagulant
Vitamin K antagonist
LMWH
Statins
Epidemiology
Antiplatelet drugs
All authors
Rein, N. van
Editor(s)
Rein N. van
Supervisor
Reitsma, P.H.
Co-supervisor
Lijfering, W.M.
Committee
Rosendaal, F.R.; Guchelaar, H.J.; Jong-van der Berg, L.T.W. de; Leebeek, F.W.G.
Qualification
Doctor (dr.)
Awarding Institution
Medicine, Leiden University
Date
2017-09-06
ISBN (print)
9789461827890

Funding

Sponsorship
Federatie Nederlandse Trombosediensten, Dutch Heart Foundation, Koninklijke Nederlandse Maatschappij ter bevordering van de Pharmacie. Stago, Pfizer, Bayer, Chipsoft, Micronic Holding B.V.