What question did this study set out to answer?

The study evaluates clinical outcomes in patients with atrial fibrillation at high risk for bleeding and stroke based on their use of oral anticoagulation.

January 10, 2026Open Access

Real-World outcomes of oral anticoagulation in patients with atrial fibrillation at high risk of both bleeding anand Asia-Pacificd stroke: observational evidence from three international registries from middle East, Europe

Q: What does this research mean for the field?

In patients with atrial fibrillation at high risk, OAC non-users had higher odds of all-cause death (aOR 2.23), MACE (aOR 1.92), and major bleeding (aOR 2.38) compared to OAC users. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

AAAmir AskarinejadElectrophysiology TBTommaso BucciUniversity of Liverpool ETEnrico TartagliaElectrophysiology

Key Result

In patients with AF at high risk, OAC non-users had higher odds of all-cause death (aOR 2.23), MACE (aOR 1.92), and major bleeding (aOR 2.38) compared to OAC users.

Key Points

The study evaluates clinical outcomes in patients with atrial fibrillation at high risk for bleeding and stroke based on their use of oral anticoagulation.
Data analyzed from three international registries across the Middle East, Europe, and Asia-Pacific
Included patients with CHA₂DS₂-VASc scores ≥ 2 and HAS-BLED scores ≥ 3
Divided patients into users and non-users of oral anticoagulation
Conducted multivariable adjustments for outcomes analysis
OAC non-users had higher 1-year event rates for all-cause death (23.3%), MACE (19.3%), and major bleeding (6.2%)
Adjusted odds ratios indicated non-users had a 2.23 times higher risk of all-cause death and 1.92 times higher risk for MACE
Enrolment in non-European settings associated with lower risk of all-cause death (aOR 0.61) and MACE (aOR 0.42)

Structured PICO

Does oral anticoagulation therapy reduce net adverse clinical events in patients with atrial fibrillation at high risk of both bleeding and stroke?

Population

2,535 patients with atrial fibrillation (AF) at high risk for both bleeding and stroke (CHA₂DS₂-VASc scores ≥ 2 and HAS-BLED scores ≥ 3), mean age 75.4 ± 7.8 years, 41.7% female, from three registries across the Middle East, Europe, and Asia-Pacific regions.

Intervention

Oral anticoagulation (OAC) therapy

Comparator

No oral anticoagulation (OAC non-users)

Outcome

Net adverse clinical events (NACE), defined as a composite of all-cause death, a thromboembolic event or an acute coronary syndrome, or major bleeding at 1-year follow-upcomposite

In patients with atrial fibrillation at high risk for both stroke and bleeding, withholding oral anticoagulation is associated with significantly worse clinical outcomes, including higher mortality, MACE, and major bleeding.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract To evaluate the clinical course of patients with AF at high risk for both bleeding and stroke, according to OAC use. Data were analysed from three registries across the Middle East, Europe, and Asia-Pacific regions. The study only included ‘high risk’ patients with AF and CHA₂DS₂-VASc scores ≥ 2 and HAS-BLED scores ≥ 3, who were divided into two groups based on OAC use: OAC users and OAC non-users . Of the 2,535 patients (41.7% female; mean age 75.4 ± 7.8 years), 80.3% ( n = 2,037) received OAC therapy. OAC non‑users showed significantly higher crude 1‑year event rates of all‑cause death (116 23.3%), MACE (96 19.3%) and major bleeding (31 6.2%); after multivariable adjustment, they had higher odds of all‑cause death (adjusted odds ratio (aOR) 2.23, 95% CI 1.65–3.01), MACE (aOR 1.92, 95% CI 1.38–2.64) and major bleeding (aOR 2.38, 95% CI 1.42–3.92) compared to OAC users . Enrolment in a non-European setting was associated with a lower risk of all-cause death (aOR 0.61, 95%CI 0.44–0.85) and MACE (aOR 0.42, 95%CI 0.28–0.62). In patients with AF at high risk of both bleeding and stroke, OAC non-use was associated with higher risk of adverse events and bleeding. Decisions on discontinuation of OACs in this subset of patients with AF should be cautiously made and such patients require careful re-evaluation and follow-up. Graphical abstract

اسأل الذكاء الاصطناعي

Bookmark

View Full Paper