PB0569 - Elevated International Normalized Ratio in Hospitalized Patients Treated with Direct Oral Anticoagulants

Monday, June 26, 2023

18:30 – 19:30 ET

Room: Exhibition

Presenting Author(s)

Orly Efros, MD, MHA (she/her/hers)

Physician, thrombosis and hemostasis specialist
National Hemophilia Center and Thrombosis & Hemostasis Institute, Sheba Medical Center, Israel. Sackler Faculty of Medicine, Tel Aviv University, Israel.
Rishon Letzion, HaMerkaz, Israel

Co-Author(s)

Gili Kenet, MD

Director
The National Hemophilia Center, and Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel
Yehud-Monosson, HaMerkaz, Israel
AL

Aharon Lubetsky

Director, Thrombosis and Hemostasis Unit
National Hemophilia Center and Thrombosis & Hemostasis Institute, Sheba Medical Center, Israel. Sackler Faculty of Medicine, Tel Aviv University, Israel.
Ramat Gan, HaMerkaz, Israel
EK

Eyal Klang

Head of the Sami Sagol AI Hub at ARC Innovation
Arc Innovation Center, Sheba Medical Center, Israel. Sackler Faculty of Medicine, Tel Aviv University, Israel.
Ramat Gan, HaMerkaz, Israel
ss

shelly soffer

Physician, internal medicine resident
Internal Medicine B, Assuta Medical Center, Israel. Ben-Gurion University of the Negev, Israel
Tel Aviv, HaMerkaz, Israel
NB

Noam Barda

Head of the Real World Evidence Research and Innovation Lab, ARC Innovation Center
ARC Innovation Center, Sheba Medical Center, Ramat-Gan, Israel. Software and Information Systems Engineering, Ben Gurion University, Be’er Sheva, Israel. 6 Epidemiology, Biostatistics and Community Health Services, Ben-Gurion University of the Negev, Be’er Sheva, Israel.
Ramat Gan, HaMerkaz, Israel
AL

Avshalom Leibowitz

Head, Internal Medicine Department D
Department of Internal Medicine “D” and Hypertension unit, Sheba Medical Center, Israel. Sackler Faculty of Medicine, Tel Aviv University, Israel.
Ramat Gan, HaMerkaz, Israel

Background: Direct oral anticoagulants (DOACs), and direct anti-Xa in particular, are associated with a prolonged prothrombin time and an increase in the international normalized ratio (INR). The clinical significance of these laboratory changes is unclear.

Aims: This study aimed to examine the association between elevated INR on hospital admission and in-hospital mortality as well as long-term survival in patients treated with DOACs.

Methods: We retrieved all patients treated with a direct oral anticoagulant who were hospitalized in a medical department at Sheba Medical Center between November 2008 and July 2022 and were tested for INR levels upon admission. The association between elevated INR (>1.5) and in-hospital death and the risk of death in the year following discharge were evaluated using logistic and Cox proportional hazards regression, respectively. Analyses were adjusted for sex, age, background diseases, and albumin level. Additionally, we examined whether the risk is altered for the different DOACs used (rivaroxaban, apixaban, and dabigatran).

Results: A total of 9,820 patients were included. Patients with elevated INR had a 138% higher risk of in-hospital mortality (Odds Ratio [OR]=2.38, 95% conﬁdence interval [CI] 1.92-2.94) and a 36% increased risk of death during the following year (Hazard Ratio [HR]=1.36; 95% CI 1.24–1.49). Subgroup analyses demonstrated that the risk was significantly increased with dabigatran (hazard ratio, 1.44; 95% conﬁdence interval, 1.03-2.02) and apixaban (hazard ratio, 1.49; 95% conﬁdence interval, 1.33-1.67), but not with rivaroxaban (hazard ratio, 1.10; 95% conﬁdence interval, 0.92-1.32).

Conclusion(s): In conclusion, an elevated INR on admission is associated with a higher risk for in-hospital death and increased risk for mortality during the first year following hospitalization in patients treated with DOACs. The risk is significantly increased with apixaban and dabigatran but not with rivaroxaban. This study suggests that measuring INR in hospitalized patients treated with DOACs may aid in assessing patients’ prognoses.