Risk factors of anticoagulation-related bleeding in hospitalized patients: a systematic review and meta-analysis

OBJECTIVE: This systematic review and meta-analysis aimed to identify and evaluate risk factors for bleeding in hospitalized patients receiving anticoagulation therapy. METHODS: Cochrane, Embase, and PubMed were searched from database inception until 20 November 2024, to identify studies exploring associations between risk factors and anticoagulation-related bleeding. Study quality was assessed using the PROBAST for risk assessment model studies and the QUIPS for prognostic factor studies. We rated the certainty of evidence for each factor using the GRADE framework. We calculated pooled odd ratios (ORs) with 95% Confidence interval [CI] using random-effects meta-analyses. RESULTS: This review included 29 studies, assessing 93 factors, 37 of which were associated with bleeding. We found high certainty evidence of an association between the bleeding risk and the following factors: gastrointestinal ulcers (OR 4.21, 95% CI 2.82-6.28), anemia (OR 3.24, 95% CI 2.08-5.06), medical procedures (OR 2.20, 95% CI 1.53-3.17), renal failure (OR 1.81, 95% CI 1.40-2.35), co-administration of antiplatelet agents (OR 1.78, 95% CI 1.48-2.14), concomitant use of bleeding-related drugs such as nonsteroidal anti-inflammatory drugs and corticosteroids (OR 2.67, 95% CI 2.13-3.33). CONCLUSION: Our results highlight comorbidity and medication factors associated with in-hospital bleeding related to anticoagulants. STUDY REGISTRATION: PROSPERO CRD42025648123.