Abstract 17225: Therapeutic Strategies Following Major Bleeding in Atrial Fibrillation: Findings From ORBIT-AF
Background: Little information exists on clinical characteristics and treatment patterns of patients with atrial fibrillation (AF) following a major bleeding event in clinical practice.
Methods: We used data from a large, national outpatient registry, ORBIT-AF (2010 – 2011), to evaluate event characteristics and oral anticoagulation (OAC) management following a major bleeding event. Major bleeds were defined according to ISTH criteria. We compared baseline characteristics among patients who persisted on OAC therapy at the first clinic visit following a major bleed and those in whom OAC was discontinued using chi-squared tests.
Results: Of 10135 patients enrolled in ORBIT-AF, n=791 (7.8%) bleeding events occurred during 2 years of follow-up. Among patients who were receiving OA, n=632 (3.5 per 100 person years) experienced a major bleed. Of these, 67.3% experienced a fall in hemoglobin and 46.8% required transfusion of 2 of more units of red blood cells. Critical site bleeding occurred in 150 OAC patients, with the majority of these classified as intracranial bleeding (n= 89), followed by retroperitoneal (n=25) and intraocular (n=17). Fatal bleeds occurred in 37 patients (5.9% of all major bleeds). Nearly one-third of patients (31.0%) discontinued OAC therapy following the major bleeding event. Compared with those who persisted on OAC, patients who discontinued OAC were more likely to have hypertension and CKD. Those who discontinued OAC were more likely to have gastrointestinal or CNS site bleeding compared with those who persisted (Table).
Conclusions: One in three patients who experienced a major bleed were no longer optimally anticoagulated after the event. Those who discontinued OAC had a greater comorbidity burden and more likely to have bleeding in a critical site those who persisted on OAC.
Author Disclosures: E.C. O'Brien: Research Grant; Modest; BMS and Janssen. Consultant/Advisory Board; Modest; Portola. D.N. Simon: None. G.C. Fonarow: Consultant/Advisory Board; Modest; Medtronic, Amgen, Johnson & Johnson, Bayer, Boston Scientific. Research Grant; Significant; NIH. Consultant/Advisory Board; Significant; Novartis. J.E. Ansell: Consultant/Advisory Board; Modest; Bristol Myers Squibb, Pfizer, Janssen, Daiichi, Boehringer Ingelheim, Alere. P.R. Kowey: Consultant/Advisory Board; Modest; Boehringer Ingelheim, Bristol Myers Squibb, Johnson & Johnson, Portola, Merck, Sanofi, Daiichi Sankyo. B.J. Gersh: Consultant/Advisory Board; Modest; Armetheon Inc, Cipla Limited, Janssen Scientific Affairs LLC, Medtronic, Inc. Other; Modest; Baxter Healthcare, Boston Scientific, Cardiovascular Research Foundation, Cardiovascular Research Foundation, Janseen Research & Development LLC, Mount Sinai St. Lukes, St. Jude Medical, Inc, Teva Pharmaceutical Industries, Thrombosis Research Institute. K. Mahaffey: Research Grant; Modest; AstraZeneca, Amgen, Bayer, Boehringer-Ingleheim, Bristol-Myers-Squibb, Daiichi Sankyo, Eli Lilly, GlaxoSmithKline, Johnson & Johnson,, Merck, Novartis, Portola, POZEN Pharmaceutical, Schering-Plough, and The Medicines Company. Consultant/Advisory Board; Modest; Amgen, AstraZeneca, Glaxo SmithKline, Johnson & Johnson, and Merck. E.D. Peterson: Research Grant; Modest; Eli Lilly & Company and Janssen. J.P. Piccini: Research Grant; Modest; Boston Scientific Corporation and Janssen. Consultant/Advisory Board; Modest; Forest Laboratories, Janssen, and Medtronic. E.M. Hylek: Consultant/Advisory Board; Modest; Bayer, Boehringer-Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Janssen, Medtronic, Pfizer.
- © 2015 by American Heart Association, Inc.