Arrhythmias & electrophysiology
Clinical phenotype of anticoagulant discontinuation and the long-term prognosis in atrial fibrillation patients with high bleeding risk: A report from the GLORIA-AF registry
Authors' conclusion
Being an older patient with frailty and having chronic kidney disease, chronic obstructive pulmonary disease, peripheral arterial disease, multimorbidity, and polypharmacy were risk factors for OAC discontinuation. OAC discontinuation was independently associated with a higher risk of mortality, major bleeding, TE, and MACE in patients with AF at high risk of bleeding.
Study context
- Population
- Patients with atrial fibrillation (AF) at high bleeding risk (HAS-BLED score of ≥3) on oral anticoagulants (OACs)age 74.9 ± 7.3 years, 39.5% male, HAS-BLED score of ≥3
- Participants
- 3,131 patients
- Exposure
- by OAC discontinuation
- stopped OACn = 633
Methodological detailsCox regression, multivariate adjustment
- Cox regression
- Multivariate adjustment
Main finding
As reported in the abstract
Stopped OAC during follow-up
633
20.2%
Observational data: associations, not effects.
Further findings
Factors associated with OAC discontinuation
| Comparison | HR (95% CI) | P value | |
|---|---|---|---|
| Age of ≥80 years · After multivariate adjustment | 1.26 (1.05–1.50) | ||
| Older with frailty · After multivariate adjustment | 1.33 (1.12–1.94) | ||
| Chronic kidney disease · After multivariate adjustment | 1.36 (1.14–1.63) | ||
| Chronic obstructive pulmonary disease · After multivariate adjustment | 1.56 (1.20–2.03) | ||
| Peripheral arterial disease · After multivariate adjustment | 1.38 (1.03–1.87) | ||
| Multimorbidity · After multivariate adjustment | 1.68 (1.20–2.36) | ||
| Polypharmacy · After multivariate adjustment | 1.59 (1.24–2.05) | ||
| 0.512Hazard ratio (log scale) |
Clinical events after OAC discontinuation
| Comparison | HR (95% CI) | P value | |
|---|---|---|---|
| Stopped OAC · all-cause death; higher risk | 1.74 (1.35–2.25) | ||
| Stopped OAC · CV death; higher risk | 2.01 (1.34–3.03) | ||
| Stopped OAC · MACE; higher risk | 2.37 (1.79–3.14) | ||
| Stopped OAC · TE; higher risk | 1.96 (1.28–2.99) | ||
| Stopped OAC · stroke; higher risk | 2.42 (1.57–3.73) | ||
| Stopped OAC · myocardial infarction; higher risk | 2.02 (1.12–3.66) | ||
| 0.20.5125Hazard ratio (log scale) |
| Outcome | Stopped OAC | Vitamin K antagonist | Non-vitamin K oral anticoagulants | Estimate | P value | |
|---|---|---|---|---|---|---|
| Incidence of OAC discontinuation by OAC type · higher with vitamin K antagonist | Not reported in the abstract | 23.1% | 19.3 | P = 0.026 | stopped OAC: not reported in the abstract |
Consistency across regions and OAC type
- OAC discontinuation rate was consistent across regions
- The risk of clinical events was similar in the vitamin K antagonist and non-vitamin K oral anticoagulant groups
Safety
Major bleeding after OAC discontinuation
| Comparison | HR (95% CI) | |
|---|---|---|
| Stopped OAC · higher risk | 4.35 (2.79–6.78) | |
| 0.10.31310Hazard ratio (log scale) |
Original publication
Summarised from the published abstract; every number is checked against it