Health-related quality of life after adverse bleeding events associated with antithrombotic drug therapy – A systematic review

• Main Authors: Lodewijk C.S. Res, Bart Lubberts, Shivesh H. Shah, Christopher W. DiGiovanni
• Format: Article
• Language: English
• Published: Elsevier 2019-01-01
• Series: Hellenic Journal of Cardiology
• Online Access: http://www.sciencedirect.com/science/article/pii/S1109966618301313

Little is known about the health-related quality of life (HRQOL) following adverse bleeding events associated with antithrombotic drug therapy. This systematic review assesses the HRQOL of patients who suffered a bleeding event related to antithrombotic drug use. A literature search was performed using PubMed, EMBASE, and the Cochrane Library from inception through June 16, 2017. Studies measuring HRQOL after a bleeding event related to antithrombotic drug therapy for primary or secondary prevention of a thromboembolic event were included. Four studies with a total of 13,209 patients met the inclusion criteria, and of them, 3,649 patients developed a bleeding event. Patients who were included received antithrombotic drugs because of acute myocardial infarction or atrial fibrillation. EQ-5D, SF-36, and GHP MOS-13 were used to measure HRQOL. The follow-up time ranged from 6 to 29 months. Patients who suffered a bleeding event reported worse HRQOL compared to those who did not (EQ-5D – average increase on all domains of 0.09, p-values ranging from <0.001 to 0.003; SF-36 – average decrease on all domains of 21.4, p < 0.001; and GHP MOS-13 score – decrease of 11.9 points, p < 0.05) and an increased health concern (13.4-point increase; p < 0.05). In conclusion, adverse bleeding events occurring because of the use of antithrombotic agents are associated with a clinically relevant lower HRQOL and hence deserve more attention as part of the shared decision-making process between patients and providers. These data should be valuable for facilitating more substantive care and risk discussions regarding potential changes in outcome and rehabilitation. Keywords: Health-related quality of life, Bleeding event, Antithrombotic drug therapy, Myocardial infarction, Atrial fibrillation