Bleeding and ischaemic events after first bleed in anticoagulated atrial fibrillation patients: risk and timing
| العنوان: | Bleeding and ischaemic events after first bleed in anticoagulated atrial fibrillation patients: risk and timing |
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| المؤلفون: | Pascal B Meyre, Steffen Blum, Elisa Hennings, Stefanie Aeschbacher, Tobias Reichlin, Nicolas Rodondi, Jürg H Beer, Annina Stauber, Andreas Müller, Tim Sinnecker, Elisavet Moutzouri, Rebecca E Paladini, Giorgio Moschovitis, Giulio Conte, Angelo Auricchio, Alexandra Ramadani, Matthias Schwenkglenks, Leo H Bonati, Michael Kühne, Stefan Osswald, David Conen |
| المساهمون: | University of Zurich, Clinical sciences |
| المصدر: | European Heart Journal. 43:4899-4908 |
| بيانات النشر: | Oxford University Press (OUP), 2022. |
| سنة النشر: | 2022 |
| مصطلحات موضوعية: | Stroke, death, Atrial Fibrillation, Oral Anticoagulation, 610 Medicine & health, 10060 Epidemiology, Biostatistics and Prevention Institute (EBPI), bleeding, outcomes, Cardiology and Cardiovascular Medicine, 360 Social problems & social services |
| الوصف: | Aims To determine the risk of subsequent adverse clinical outcomes in anticoagulated patients with atrial fibrillation (AF) who experienced a new bleeding event. Methods and results Anticoagulated AF patients were followed in two prospective cohort studies. Information on incident bleeding was systematically collected during yearly follow-up visits and events were adjudicated as major bleeding or clinically relevant non-major bleeding (CRNMB) according to the International Society on Thrombosis and Haemostasis guidelines. The primary outcome was a composite of stroke, myocardial infarction (MI), or all-cause death. Time-updated multivariable Cox proportional-hazards models were used to compare outcomes in patients with and without incident bleeding. Median follow-up was 4.08 years [interquartile range (IQR): 2.93–5.98]. Of the 3277 patients included (mean age 72 years, 28.5% women), 646 (19.7%) developed a new bleeding, 297 (9.1%) a major bleeding and 418 (12.8%) a CRNMB. The incidence of the primary outcome was 7.08 and 4.04 per 100 patient-years in patients with and without any bleeding [adjusted hazard ratio (aHR): 1.36, 95% confidence interval (CI): 1.16–1.61; P < 0.001; median time between a new bleeding and a primary outcome 306 days (IQR: 23–832)]. Recurrent bleeding occurred in 126 patients [incidence, 8.65 per 100 patient-years (95% CI: 7.26–10.30)]. In patients with and without a major bleeding, the incidence of the primary outcome was 11.00 and 4.06 per 100 patient-years [aHR: 2.04, 95% CI: 1.69–2.46; P < 0.001; median time to a primary outcome 142 days (IQR: 9–518)], and 59 had recurrent bleeding [11.61 per 100 patient-years (95% CI: 8.99–14.98)]. The incidence of the primary outcome was 5.29 and 4.55 in patients with and without CRNMB [aHR: 0.94, 95% CI: 0.76–1.15; P = 0.53; median time to a composite outcome 505 days (IQR: 153–1079)], and 87 had recurrent bleeding [8.43 per 100 patient-years (95% CI: 6.83–10.40)]. Patients who had their oral anticoagulation (OAC) discontinued after their first bleeding episode had a higher incidence of the primary composite than those who continued OAC (63/89 vs. 159/557 patients; aHR: 4.46, 95% CI: 3.16–6.31; P < 0.001). Conclusion In anticoagulated AF patients, major bleeding but not CRNMB was associated with a high risk of adverse outcomes, part of which may be explained by OAC discontinuation. Most events occurred late after the bleeding episode, emphasizing the importance of long-term follow-up in these patients. |
| وصف الملف: | ehac587.pdf - application/pdf |
| تدمد: | 1522-9645 0195-668X |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::7e353b68d87b2404fde0fcf6e539e703 https://doi.org/10.1093/eurheartj/ehac587 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....7e353b68d87b2404fde0fcf6e539e703 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15229645 0195668X |
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