Abstract 19812: Temporal Discordance of Atrial Fibrillation Burden With Major Bleeding and Intracranial Hemorrhage: Implications for Oral Anticoagulation Therapy
Introduction: In atrial fibrillation (AF), oral anticoagulation, which is taken daily without regard to pattern or presence of AF, categorically increases risk of major bleeding and intracranial hemorrhage (ICH). However, most patients with cardiac implantable electronic devices (CIED) do not have AF at time of ischemic stroke. A similar temporal discordance of AF may occur with bleeding events.
Methods: We linked CIED remote monitoring (RM) data for the full denominator of Veterans Administration (VA) serviced patients to VA and Medicare inpatient and outpatient claims from 2003-2014. Analysis was restricted to Medtronic devices (PPM, ICD, CRT) with atrial leads (n=13,216), which provide a daily, continuous measure of AF burden. We identified patients who experienced a major bleeding event (MBE), including ICH. Patients were classified into four categories of AF ≥ 6 minutes being present on any of the 90 days before (including day of MBE) and after MBE: NO/NO, NO/YES, YES/NO, YES/YES.
Results: There were 256 patients with MBE and ≥ 90 days of pre and post RM (1.9% of cohort, 71±9.8 years, CHA2DS2-VASc 4.4±1.5). Of these, 61% had no AF pre- and post-MBE (NO/NO); 5.9% NO/YES; 7.8% YES/NO; 26% YES/YES. Baseline clinical variables, comorbidity scores, and stroke risk scores did not discriminate between these groups. Of the 31 patients with ICH, only 9 had AF on the day of bleed or in the 90 days prior. Findings were similar when AF cutoffs were varied from 30 sec to 6 hours (TABLE) or when AF time windows were extended to 180 days pre and post.
Conclusion: Among patients with CIEDs, the majority had MBE and ICH during long AF-free periods. These data suggest that ongoing trials of ad hoc anticoagulation, if noninferior for stroke prevention, are likely to have measurable reductions in major bleeding.
Author Disclosures: M. Askari: None. P.D. Ziegler: Employment; Significant; Medtronic, Inc.. J. Fan: None. S.K. Schmitt: None. M.P. Turakhia: Research Grant; Modest; Medtronic, Inc., iRhythm Technologies. Research Grant; Significant; Janssen Pharmaceuticals, Inc. Speakers Bureau; Modest; Medtronic, Inc.. Honoraria; Modest; Medtronic, Inc., Daiichi, Sankyo Pharmaceuticals., St Jude Medical, Precision Health Economics. Consultant/Advisory Board; Modest; Medtronic, Inc., Daiichi, Sankyo Pharmaceuticals., St Jude Medical, Precision Health Economics.
- © 2016 by American Heart Association, Inc.