Risk factors of bleeding in patients with atrial fibrillation undergoing percutaneous coronary intervention: an analysis from the MANJUSRI study

Background The risk factors of bleeding related to dual or triple therapy in patients with atrial fibrillation after percutaneous coronary intervention (PCI) are not fully explored. We addressed this issue on patients enrolled in the MANJUSRI trial. Methods Data of patients assigned to the dual therapy group (ticagrelor + warfarin, Dual group) and the triple group (clopidogrel + aspirin + warfarin, Triple group) in the MANJUSRI trial were analyzed. Multivariate regression analysis was used to determine the risk factors of bleeding among enrolled patients. Results The incidence of overall bleeding at 6 months was 36.49% in the dual group and 35.62% in the triple group ( P > 0.05). Multivariate cox regression analysis showed that alcohol consumption was positively correlated with overall bleeding in the total cohort (OR = 3.905, P = 0.001) and in the dual therapy group (OR = 4.643, P = 0.034). Age was positively associated with overall bleeding risk (OR = 1.059, P = 0.032), while body mass index was negatively associated with overall bleeding risk (OR = 0.911, P = 0.048) in the triple therapy group. Conclusions Alcohol consumption increased the risk of overall bleeding after PCI in atrial fibrillation patients, especially in patients treated with warfarin and ticagrelor. Aging also increased bleeding risk in the whole cohort. Lower body weight contributed significantly to increased risk of overall bleeding in AF patients post PCI receiving combined clopidogrel, aspirin and warfarin medications. Above factors should be considered in terms of individualized anticoagulation management in AF patients post PCI aiming to reduce their bleeding risk. Clinical Trial Registration https://clinicaltrials.gov/study/NCT02206815 , identifier NCT02206815.