Abstract 16800: Anemia Predicts Bleeding and Mortality, but Not Stroke, in Patients With Atrial Fibrillation: Insights From the ARISTOTLE Trial
Objective: Patients with atrial fibrillation (AF) are prone to cardiovascular events and anticoagulant-related bleeding complications. We tested the hypothesis that chronic anemia is associated with increased risk for any of these outcomes.
Methods and Results: We retrospectively analyzed the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial which included 18,201 patients with AF randomized to warfarin (target INR 2.0-3.0) or apixaban 5 mg bid. Cox regression analysis was used to determine if anemia predicted future stroke, major bleeding, or mortality. Anemia (defined as Hb<13.0 g/dL in men and Hb<12.0 g/dL in women) was present at baseline in 12.6 % of the ARISTOTLE population. Patients with anemia (vs. without) were older (median 73 vs. 69 years), had higher mean CHADS2 score (2.4 vs. 2.1), and were more likely to have experienced previous bleeding events (mean 20.1% vs. 16.2%). Anemia predicted all-cause mortality (adjusted HR 1.68, 95% CI 1.46-1.93; p<0.0001) and major bleeding (adjusted HR 1.92, 95% CI 1.62-2.28; p<0.0001). Apixaban had consistent benefits over warfarin for lower stroke rate (p interaction 0.26), lower mortality (p interaction 0.15), and less bleeding (p interaction 0.57) (Figure) in patients with or without anemia. Anemia did not predict stroke (adjusted HR 0.920, 95% CI 0.696-1.214), but was the strongest predictor of bleeding. Anemia is therefore one of the few factors that has a differential impact on the risk of bleeding and stroke.
Conclusions: Chronic anemia predicts higher risk of bleeding complications and mortality, but not stroke, in anticoagulated patients with AF. This information is important to construct algorithms differentially predicting stroke and bleeding. Apixaban has similar benefits among patients with and without baseline anemia.
Author Disclosures: B. Westenbrink: None. M. Alings: Consultant/Advisory Board; Modest; Bayer, Boehringer Ingelheim, BMS/Pfizer, MSD, Sanofi Aventis. C.B. Granger: Research Grant; Significant; Medtronic Foundation, Bristol-Myers Squibb, Sanofi Aventis, Boehringer Ingelheim, The Medicines Company, Takeda, GlaxoSmithKline, Pfizer, Merck. Consultant/Advisory Board; Modest; Bristol-Myers Squibb, AstraZeneca, Daiichi Sankyo, GlaxoSmithKline, Pfizer, The Medicines Company, Hoffman LaRoche, Takeda, Lilly, Sanofi Aventis, Boehringer Ingelheim, Ross Medical Corporation. J.H. Alexander: Research Grant; Significant; Bristol-Myers Squibb, Boehringer Ingelheim, CLS Behring, NIH, Oxygen Biotherapeutics, Perosphere, Regado Biosciences, Vivus Pharmaceuticals. Consultant/Advisory Board; Modest; Bristol-Myers Squibb, Portola, Regado Biosciences. Consultant/Advisory Board; Significant; Bristol-Myers Squibb. R.D. Lopes: Research Grant; Significant; Bristol-Myers Squibb, GlaxoSmithKline. Consultant/Advisory Board; Modest; Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, GlaxoSmithKline, Pfizer. L. Thomas: None. D.M. Wojdyla: None. M. Hanna: Employment; Significant; Bristol-Myers Squibb. M. Keltai: None. P. Steg: Research Grant; Significant; Sanofi Aventis, Servier. Ownership Interest; Significant; Aterovax. Consultant/Advisory Board; Modest; Amarin, Bayer, Bristol-Myers Squibb, Daiichi Sankyo, GlaxoSmithKline, Lilly, Merck, Pfizer, The Medicines Company, Vivus, Novartis, Otsuka. Consultant/Advisory Board; Significant; AstraZeneca, Sanofi Aventis, Servier. R. De Caterina: Research Grant; Modest; Sanofi Aventis, Boehringer Ingelheim, Bayer, BMS/Pfizer. Research Grant; Significant; Daiichi Sankyo. Honoraria; Modest; Sanofi Aventis, Boehringer Ingelheim, Bayer, BMS/Pfizer. L. Wallentin: Research Grant; Significant; Boehringer Ingelheim, AstraZeneca, GlaxoSmithKline, Merck/Schering Plough, Bristol-Myers Squibb/Pfizer. Consultant/Advisory Board; Modest; Abbott, AstraZeneca, Bristol-Myers Squibb/Pfizer, GlaxoSmithKline, Regado Biosciences, Boehringer Ingelheim, Athera Biotechnologies. Other; Significant; AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Bristol-Myers Squibb/Pfizer. W. van Gilst: None.
- © 2014 by American Heart Association, Inc.