Minor bleeding not tied to risk of major bleeding in AF patients

By Will Boggs MD

NEW YORK (Reuters Health) - Minor bleeding events, or "nuisance bleeding", in patients with atrial fibrillation (AF) on oral anticoagulants are not associated with increased rates of major bleeding or embolism in the short term, according to results from the ORBIT-AF registry.

Nuisance bleeding often influences decisions regarding discontinuation of oral anticoagulant therapy, especially in older patients. But few data are available as to whether these milder bleeding events predict major bleeding events in patients with AF, Dr. Emily O'Brien from Duke Clinical Research Institute, in Durham, North Carolina, and colleagues note in Circulation, online April 20.

The team examined the association between non-major bleeding events and future adverse clinical events, including stroke/non-central nervous system systemic embolism (SSE) and major bleeding, in their analysis of 6,771 patients (18,560 patient visits).

Most visits (85.2%) were on warfarin therapy, with the remaining 14.8% of visits on non-vitamin K antagonists.

Over a median follow-up of 1.5 years, 20% of patients experienced nuisance bleeding (14.8 events per 100 patient-years).

CHA2DS2-VASc and ATRIA bleeding scores were comparable between patients who experienced nuisance bleeding and those who did not.

After nuisance bleeding events, 27.2% of patients were switched to a lower dose of oral anticoagulant at their next visit; 24.4% of patients who did not experience nuisance bleeding were also switched to a lower oral anticoagulant dose after six to 12 months.

The odds of experiencing major bleeding did not differ between patients who experienced nuisance bleeding and those who did not over six months, neither before nor after adjustment of bleeding scores.

Similarly, there was no significant difference in the odds of experiencing SSE between patients who experienced nuisance bleeding and those who did not.

Among 288 patients experiencing a nuisance bleeding event who completed the Anti-Clot Treatment Scale, there was no change in self-reported anticoagulation satisfaction from before to after the nuisance bleeding event.

"Collectively, our findings provide reassurance that continuation of oral anticoagulants in patients with nuisance bleeding appears to not lead to increased risk for major adverse events," the researchers conclude.

Dr. Menno V. Huisman from Leiden University Medical Center, in the Netherlands, who has studied bleeding risk in patients on anticoagulant and antithrombotic treatment, told Reuters Health by email, "When nuisance bleeding occurs, we have to talk to our patient and reassure her or him that this is not necessarily a signal of a bleeding tendency."

"Nuisance bleeding is not a foreboder of major bleeding," said Dr. Huisman, who was not involved in the new work.

Dr. O'Brien could not be reached for comments.

SOURCE: https://bit.ly/2HKUUGv

Circulation 2018.