Key result
High bleeding risk linked to ~9-point lower oral anticoagulant use in AF.
Why the study?
Oral anticoagulant therapy in atrial fibrillation patients is associated with hemorrhagic complications, and clinical characteristics and treatment patterns in high bleeding risk patients require evaluation.
Cross-Sectional (n=3,598)
Yes
Absolute Event Rate: 85.5% vs 94.1%
p-value: p=<0.001
A substantial proportion of atrial fibrillation patients with a high risk of bleeding do not receive oral anticoagulation or are prescribed inappropriately reduced NOAC doses, highlighting a persistent gap between clinical guidelines and real-world practice.
High-bleeding-risk AF patients receive OAC less often; leaves open whether targeted strategies can safely increase appropriate use.
BACKGROUND: Despite its benefits, oral anticoagulant (OAC) therapy in patients with atrial fibrillation (AF) is associated with hemorrhagic complications. AIMS: We aimed to evaluate clinical characteristics of AF patients at high risk of bleeding and the frequency of OAC use as well as identify factors that predict nonuse of OACs in these patients. METHODS: Consecutive AF patients hospitalized for urgent or planned reasons in cardiac centers were prospectively included in the registry in 2019. Patients with HAS-BLED ≥3 (high HAS-BLED group) were assumed to have a high risk of bleeding. RESULTS: Among 3598 patients enrolled in the study, 29.2% were at high risk of bleeding (44.7% female; median [Q1-Q3] age 72 [65-81], CHA2DS2-VASc score 5 [4-6], HAS-BLED 3 [3-4]). In this group, 14.5% of patients did not receive OACs, 68% received NOACs, and 17.5% VKAs. In multivariable analysis, the independent predictors of nonuse of oral OACs were as follows: creatinine level (odds ratio [OR], 1.441; 95% confidence interval [CI], 1.174-1.768; P <0.001), a history of gastrointestinal bleeding (OR, 2.918; 95% CI, 1.395-6.103; P = 0.004), malignant neoplasm (OR, 3.127; 95% CI, 1.332-7.343; P = 0.009), and a history of strokes or transient ischemic attacks (OR, 0.327; 95% CI, 0.166-0.642; P = 0.001). CONCLUSIONS: OACs were used much less frequently in the group with a high HAS-BLED score than in the group with a low score. Independent predictors of nonuse of OACs were creatinine levels, a history of gastrointestinal bleeding, and malignant neoplasms. A history of stroke or transient ischemic attack increased the chances of receiving therapy.
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Maciorowska et al. (2024) conducted a cross-sectional in Atrial fibrillation (n=3,598). High bleeding risk (HAS-BLED ≥3) vs. Low bleeding risk (HAS-BLED <3) was evaluated on Use of oral anticoagulants (OAC) (p=<0.001). Patients with atrial fibrillation at high risk of bleeding (HAS-BLED ≥3) received oral anticoagulants significantly less frequently than those at low bleeding risk (85.5% vs 94.1%).
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