History of major bleeding (present in 2.14% of patients) was independently associated with major adverse outcomes, which occurred in 9.9% of the overall cohort.
Cohort (n=3,218)
Does a history of major bleeding predict adverse clinical outcomes in patients with non-valvular atrial fibrillation?
A history of major bleeding is an independent predictor of adverse clinical outcomes in patients with non-valvular atrial fibrillation, highlighting the need to avoid inappropriate combination therapy with OAC and antiplatelets.
OBJECTIVE: To compare clinical outcomes between patients with and without history of major bleeding according to types of antithrombotic medications in patients with non-valvular atrial fibrillation (NVAF). METHODS: -VASc and HAS-BLED scores, history of bleeding and severity, investigations, and antithrombotic medications. Clinical outcomes were death, bleeding, and ischemic stroke/transient ischemic attack (TIA). RESULTS: There were a total of 3218 patients. The average age was 67.3 ± 11.3 years, and 58.3% were men. Sixty-nine patients (2.14%) had a history of major bleeding. Antithrombotic use was, as follows: 2126 patients (75.3%) received oral anticoagulant (OAC) alone, 555 (17.2%) received antiplatelet alone, 298 (9.3%) received both, and 239 (7.4%) received neither. During follow-up, 9.9% had major adverse outcomes, including death (5.9%), ischemic stroke/TIA (2.5%), and major bleeding (4.0%). There were no significant differences in the types of antithrombotic medications between patients with and without history of major bleeding. Multivariate analysis revealed old age, low body mass index, hypertension, diabetes, heart failure, and history of major bleeding to be independently associated with major adverse outcome. Adverse events significantly increased in patients with OAC plus antiplatelet. CONCLUSIONS: History of major bleeding was identified as a factor that significantly affects clinical outcome. Inappropriate use of OAC plus antiplatelet should be avoided. Special caution should be made in this high-risk patients.
Krittayaphong et al. (Wed,) conducted a cohort in non-valvular atrial fibrillation (NVAF) (n=3,218). History of major bleeding vs. No history of major bleeding was evaluated on Major adverse outcomes (death, ischemic stroke/TIA, and major bleeding). History of major bleeding (present in 2.14% of patients) was independently associated with major adverse outcomes, which occurred in 9.9% of the overall cohort.