Real-world management strategies of anticoagulated atrial fibrillation patients following a clinically significant bleeding episode: Afib patients bleeding on anticoagulants.

BACKGROUND

Systemic anticoagulation for stroke prevention in patients with atrial fibrillation (AF) carries inherent bleeding risks and determining whether and when to resume anticoagulation after a significant bleed is a common dilemma. We aimed to describe the clinical characteristics of AF patients discharged after a bleed, document real-life thromboembolic prevention strategy (TPS) and analyse their associated clinical outcomes.

METHODS

We retrospectively reviewed the charts of anticoagulated AF patients admitted for bleeding between 2017 and 2019.

RESULTS

140 patients were included with a mean age of 78.6 years. Four discharge groups were defined: 75 (53.5%) patients had optimal anticoagulation (OA), 37 (26.4%) had a suboptimal anti-thrombotic regimen (SAR: low-dose DOAC without dose-reduction criteria or anti-platelet therapy), 10 (7.1%) were referred for left atrial appendage occlusion (LAAO) and 18 (12.9%) left without any TPS. All-cause mortality at 2-years was high (28.6%) but not statistically different between groups (p=0.71). Patients discharged with a TPS (OA/SAR/LAAO referral) were more likely to be readmitted for bleeding at 2 years (34% vs 0%, p=0.002), while those discharged without a TPS had higher rates of stroke (16.6% vs 1.4%, p=0.003). Use of a SAR yielded similar readmission rates for bleeding compared to resumption of OA (27% vs 34.7%, p=0.41) but was associated with high rates of death or readmission at 2 years.

CONCLUSION

This real-life cohort reveals that clinicians frequently downgrade or discontinue long-term thromboembolic protection after a bleeding event despite current guideline recommendations to the contrary, and downgrading resulted in similar bleeding risk compared to OA.

Informations de copyright

Copyright © 2024. Published by Elsevier Inc.