{"id":32054,"date":"2014-07-29T12:17:13","date_gmt":"2014-07-29T11:17:13","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=32054"},"modified":"2017-07-02T21:46:39","modified_gmt":"2017-07-02T20:46:39","slug":"the-bmj-today-bleeding-anticoagulants-and-guerrilla-warfare","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2014\/07\/29\/the-bmj-today-bleeding-anticoagulants-and-guerrilla-warfare\/","title":{"rendered":"The BMJ Today: Bleeding anticoagulants and guerrilla warfare"},"content":{"rendered":"<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2012\/08\/rich_hurley.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-19363\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2012\/08\/rich_hurley.jpg\" alt=\"rich_hurley\" width=\"160\" height=\"160\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2012\/08\/rich_hurley.jpg 160w, https:\/\/blogs.bmj.com\/bmj\/files\/2012\/08\/rich_hurley-150x150.jpg 150w\" sizes=\"auto, (max-width: 160px) 100vw, 160px\" \/><\/a>Can we better quantify the risk of upper gastrointestinal and intracranial bleeding among patients who are taking long term oral anticoagulants for venous thromboembolism, systemic embolism, or stroke prevention? This information would help inform treatment, further investigation, or monitoring.<\/p>\n<p>A <a href=\"http:\/\/www.bmj.com\/content\/349\/bmj.g4606\">research paper published yesterday<\/a> on thebmj.com describes the newly devised \u201cQBleed algorithms.\u201d The researchers, from the University of Nottingham, found that these calculations \u201cprovided valid measures of absolute risk . . . in patients with and without anticoagulation.\u201d<!--more--><\/p>\n<p>They carried out a large open cohort study, using routinely collected data from UK general practice linked to hospital episode statistics and mortality data from 2008 to 2013. They included data about 4.4 million patients with 16.4 million person years of follow-up, during which 21 641 patients had an incident upper gastrointestinal bleed, and 9040 had an intracranial bleed.<\/p>\n<p>&#8220;This is among the largest of the outpatient derivation cohorts used in this specialty to date and provides extra power to develop more robust predictive models using more candidate covariates than other scores,\u201d <a href=\"http:\/\/www.bmj.com\/content\/349\/bmj.g4800\">said Benjamin A Steinberg in a linked Editorial<\/a>.<\/p>\n<p>The algorithms made use of 21 variables, including patients\u2019 age, sex, Townsend deprivation score, ethnicity, smoking, alcohol intake, chronic diseases, prescribed drugs, body mass index, systolic blood pressure, haemoglobin, platelets, and previous bleeding before the study.<\/p>\n<p>\u201cFurther research is needed to evaluate the clinical outcomes and the cost effectiveness of using these algorithms in primary care,\u201d wrote Steinberg. \u201cWhat magnitude of risk is too high? Is the threshold the same for every patient and every indication?\u201d<\/p>\n<p>Bleeding risks can be calculated online, at <a href=\"http:\/\/qbleed.org\">http:\/\/qbleed.org<\/a>, with open source software available to download.<\/p>\n<p>Meanwhile, in a very different vein, Jeph Mathias, a former M\u00e9decins Sans Fronti\u00e8res doctor turned environmental crusader in northern India, reflects on a time in the Colombian jungle when he shared a beer and a chat with a rebel leader, in <a href=\"http:\/\/www.bmj.com\/content\/349\/bmj.g4816\">a recently published Personal View article<\/a>.<\/p>\n<p>\u201cA hand fell on my shoulder just as I was pulling my hammock\u2019s last knot tight,\u201d he wrote. \u201cHe was just a boy . . . I was being kidnapped. \u2018Medico,\u2019 he said, \u2018the boss wants to talk.\u2019\u201d<\/p>\n<p>After fixing a child\u2019s severed extensor tendon, Mathias wrote, \u201cAn MSF doctor and FARC [the Revolutionary Armed Forces of Colombia] guerrilla met and connected.\u201d<\/p>\n<p>He concludes that the guerrilla, Che, \u201cmust be long dead\u2014malaria, leishmaniasis, a bullet, a knife\u2014but with me still are those eyes as grey as cold ash, a velvet voice, and his implied farewell: \u2018I failed. Hermano [brother] . . . Yes, heal diseases and injuries, but Medico, also heal people.\u2019\u201d<\/p>\n<p>And vote in our latest poll on <a href=\"http:\/\/bmj.com\">bmj.com<\/a>: \u201cShould boys be vaccinated against HPV as well as girls?\u201d We\u2019re publishing two articles on this issue tonight. We\u2019re keen to know what you think about these or any other articles we\u2019ve published. Leave us a rapid response: we republish the most interesting and useful as formal letters to the editor.<\/p>\n<p><em><strong>Richard Hurley\u00a0<\/strong>is\u00a0deputy magazine editor for<\/em>\u00a0<em>The BMJ.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Can we better quantify the risk of upper gastrointestinal and intracranial bleeding among patients who are taking long term oral anticoagulants for venous thromboembolism, systemic embolism, or stroke prevention? This [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2014\/07\/29\/the-bmj-today-bleeding-anticoagulants-and-guerrilla-warfare\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5750],"tags":[],"class_list":["post-32054","post","type-post","status-publish","format-standard","hentry","category-the-bmj-today"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>The BMJ Today: Bleeding anticoagulants and guerrilla warfare - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2014\/07\/29\/the-bmj-today-bleeding-anticoagulants-and-guerrilla-warfare\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"The BMJ Today: Bleeding anticoagulants and guerrilla warfare - The BMJ\" \/>\n<meta property=\"og:description\" content=\"Can we better quantify the risk of upper gastrointestinal and intracranial bleeding among patients who are taking long term oral anticoagulants for venous thromboembolism, systemic embolism, or stroke prevention? 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