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Prognostic Significance of Nuisance Bleeding in Anticoagulated Patients With Atrial Fibrillation.

Publication ,  Journal Article
O'Brien, EC; Holmes, DN; Thomas, LE; Fonarow, GC; Allen, LA; Gersh, BJ; Kowey, PR; Singer, DE; Ezekowitz, MD; Naccarelli, GV; Ansell, JE ...
Published in: Circulation
August 28, 2018

BACKGROUND: Bleeding is commonly cited as a reason for stopping oral anticoagulants (OACs). Whether minor bleeding events (nuisance bleeding, NB) in patients with atrial fibrillation on OACs are associated with OAC discontinuation, major bleeding, and stroke/systemic embolism (SSE) is unknown. METHODS: Within the ORBIT-AF prospective, outpatient registry (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation), we identified 6771 patients ≥18 years of age at 172 sites with atrial fibrillation and eligible follow-up visits. NB was ascertained from the medical record and was defined as minor bleeding that did not require medical attention (eg, bruising, hemorrhoidal bleeding). We used multivariable pooled logistic regression modeling to evaluate the associations between NB and major bleeding and SSE in the 180 days after documentation of NB. Our unit of analysis was the patient visit, occurring at ≈6-month intervals for a median of 1.5 years following enrollment. Changes in anticoagulation treatment satisfaction after NB were examined descriptively in a subset of patients. RESULTS: The median age of the overall population was 75.0 (interquartile range, 67.0-81.0); 90.0% were white and 42.5% were female. Among 6771 patients (18 560 visits), n=1357 (20.0%) had documented NB, for an incidence rate of 14.8 events per 100 person-years. Over 96.4% of patients remained on OAC therapy after the NB event. Overall, 287 (4.3%) patients experienced major bleeding and 64 (0.96%) had a SSE event during follow-up. NB was not associated with a significant increased risk of major bleeding over 6 months in models adjusting for the ATRIA bleeding score (Anticoagulation and Risk Factors in Atrial Fibrillation) (odds ratio, 1.04; 95% confidence interval, 0.68-1.60; P=0.86). NB was also not associated with increased SSE risk over 6 months in models adjusting for the CHA2DS2-VASc risk score (odds ratio, 1.24; 95% confidence interval, 0.53-2.91; P=0.62). CONCLUSIONS: NB is common among patients with atrial fibrillation on OACs. However, NB was not associated with a higher risk of major bleeding or SSE over the next 6 months, suggesting its occurrence should not lead to changes in anticoagulation treatment strategies in OAC-treated patients. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01165710.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

August 28, 2018

Volume

138

Issue

9

Start / End Page

889 / 897

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Stroke
  • Severity of Illness Index
  • Risk Factors
  • Risk Assessment
  • Registries
  • Prospective Studies
  • Patient Satisfaction
 

Citation

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Chicago
ICMJE
MLA
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O’Brien, E. C., Holmes, D. N., Thomas, L. E., Fonarow, G. C., Allen, L. A., Gersh, B. J., … Hylek, E. M. (2018). Prognostic Significance of Nuisance Bleeding in Anticoagulated Patients With Atrial Fibrillation. Circulation, 138(9), 889–897. https://doi.org/10.1161/CIRCULATIONAHA.117.031354
O’Brien, Emily C., DaJuanicia N. Holmes, Laine E. Thomas, Gregg C. Fonarow, Larry A. Allen, Bernard J. Gersh, Peter R. Kowey, et al. “Prognostic Significance of Nuisance Bleeding in Anticoagulated Patients With Atrial Fibrillation.Circulation 138, no. 9 (August 28, 2018): 889–97. https://doi.org/10.1161/CIRCULATIONAHA.117.031354.
O’Brien EC, Holmes DN, Thomas LE, Fonarow GC, Allen LA, Gersh BJ, et al. Prognostic Significance of Nuisance Bleeding in Anticoagulated Patients With Atrial Fibrillation. Circulation. 2018 Aug 28;138(9):889–97.
O’Brien, Emily C., et al. “Prognostic Significance of Nuisance Bleeding in Anticoagulated Patients With Atrial Fibrillation.Circulation, vol. 138, no. 9, Aug. 2018, pp. 889–97. Pubmed, doi:10.1161/CIRCULATIONAHA.117.031354.
O’Brien EC, Holmes DN, Thomas LE, Fonarow GC, Allen LA, Gersh BJ, Kowey PR, Singer DE, Ezekowitz MD, Naccarelli GV, Ansell JE, Chan PS, Mahaffey KW, Go AS, Freeman JV, Reiffel JA, Peterson ED, Piccini JP, Hylek EM. Prognostic Significance of Nuisance Bleeding in Anticoagulated Patients With Atrial Fibrillation. Circulation. 2018 Aug 28;138(9):889–897.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

August 28, 2018

Volume

138

Issue

9

Start / End Page

889 / 897

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Stroke
  • Severity of Illness Index
  • Risk Factors
  • Risk Assessment
  • Registries
  • Prospective Studies
  • Patient Satisfaction