Clinical predictors of recurrent strokes and bleeding in patients with atrial fibrillation receiving oral anticoagulation (20-year follow-up in the register of long-term antithrombotic therapy [REGATA-2])

Anticoagulation in patients with atrial fibrillation reduces the incidence of ischemic stroke and increase the risk of major bleeding. Despite adequate anticoagulation, some patients experience unfavorable prognostic events including recurrent ones. Objective. To evaluate the incidence and structure of clinical and laboratory predictors of recurrent prognostic events (thromboembolism and bleeding) in AF patients receiving oral anticoagulation as part of a long-term prospective follow-up. Material and methods. This fragment included 125 AF patients from the REGATA-2 registry (Register of Long-term Antithrombotic Therapy (NCT043447187) who survived the first adverse event (stroke or bleeding) and continued anticoagulation (warfarin or one of the direct oral anticoagulants). During further follow-up (median 3.6 years), prognostic-determining negative events were recorded: ischemic stroke/transient ischemic attack and bleeding BARC type 2—5. Results. Incidence of repeated prognostic events (ischemic stroke/transient ischemic attack/bleeding BARC type 2—5) was 20.6/100 patient-years. Bleedings prevailed among all events, ischemic strokes — among fatal events. Incidence of fatal events was significantly higher among patients who continued warfarin compared to DOACs. Independent predictors (Cox proportional risks model) of relapse of any prognostic event were CCI score ≥7 (HR=2.0), age <65 years (HR=2.1), diabetes mellitus (HR=2.0) and chronic kidney disease ≥3a (HR=2.2). Conclusion. Patients with any prognosis-defining event despite anticoagulation are at extremely high risk of recurrence. This necessitates an individual approach based on optimization of anticoagulation and maximum correction of all risk factors.