Key result
Chronic kidney disease (creatinine clearance <60 ml/min) increased the risk of recurrent major or clinically significant bleeding by 2.27 times (95% CI 1.1253-4.6163; p=0.0221).
Why the study?
Existing risk scales lack specificity for recurrent bleeding in AF patients resuming anticoagulation after a bleed, requiring identification of clinical and laboratory predictors to guide personalized monitoring.
What are the predictors of recurrent major and clinically significant bleeding in patients with atrial fibrillation after resuming anticoagulant therapy?
Cohort (n=95)
What are the predictors of recurrent major and clinically significant bleeding in patients with atrial fibrillation after resuming anticoagulant therapy?
Relative Risk: 2.27 (95% CI 1.1253–4.6163)
p-value: p=0.0221
In patients with atrial fibrillation resuming anticoagulation after a bleeding event, chronic kidney disease (CrCl <60 ml/min) significantly increases the risk of recurrent bleeding.
CKD was associated with higher recurrent bleeding risk after anticoagulation resumption in AF; hypothesis-generating for risk-stratified resumption strategies.
AIM: Patients with atrial fibrillation (AF) at high risk of thromboembolic complications who have had bleeding should strive to resume anticoagulant therapy. Existing traditional scales for assessing the risk of hemorrhagic complications are not highly specific for the risk of recurrent bleeding. Thus, searching is needed for clinical and laboratory predictors to identify patients who require a personalized monitoring regimen. The aim of the study was to assess the incidence rate and predictors of recurrent major and clinically significant bleeding in patients with AF after resumption of the anticoagulant therapy, as well as the contribution of changing the anticoagulant to the treatment safety. MATERIAL AND METHODS: Based on a 5-year follow-up of 95 patients with AF who have had major and clinically significant bleeding, the incidence and clinical factors determining the recurrence of hemorrhagic complications were assessed.Results According to the data of the 5-year follow-up, the recurrence rate of major/clinically significant bleeding was 16.9/100 patient-years. Changing the oral anticoagulant significantly reduced the risk of relapse after clinically significant bleeding and did not affect the risk of recurrence of major bleeding. The predictor for relapse of major/clinically significant bleeding during the therapy resumption was chronic kidney disease with a decrease in creatinine clearance to less than 60 ml/ min, which increased the risk of relapse 2.27 times (95% confidence interval: 1.1253-4.6163; p=0.0221). CONCLUSION: The development of serious bleeding in a patient at high risk of thrombotic complications always requires a reassessment of risk factors and an adequate choice and dosage of the anticoagulant. Development of a unified protocol for the management of AF patients receiving anticoagulants and having a high risk of bleeding is essential and will reduce the risk of adverse outcomes.
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Кропачева et al. (2023) conducted a cohort in Atrial fibrillation with prior major and clinically significant bleeding (n=95). Chronic kidney disease (creatinine clearance <60 ml/min) was evaluated on Relapse of major/clinically significant bleeding (RR 2.27, 95% CI 1.1253-4.6163, p=0.0221). Chronic kidney disease (creatinine clearance <60 ml/min) increased the risk of recurrent major or clinically significant bleeding by 2.27 times (95% CI 1.1253-4.6163; p=0.0221).
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