Long-term clinical outcomes after major bleeding in patients with atrial fibrillation: the fushimi AF registry

BACKGROUND: Oral anticoagulants reduce the risk of ischaemic stroke, but may increase the risk of major bleeding in atrial fibrillation (AF) patients. Little is known about the clinical outcomes of patients after a major bleeding event. This study assessed the outcomes of AF patients after major bleeding.

METHODS AND RESULTS: The Fushimi AF Registry is a community-based prospective survey of the AF patients in Fushimi-ku, Kyoto, Japan. Analyses were performed on 4,304 AF patients registered by 81 institutions participating in the Fushimi AF Registry. We investigated the demographics and outcomes of AF patients who experienced major bleeding during follow-up period. During the median follow-up of 1,307 days, major bleeding occurred in 297 patients (6.9%). Patients with major bleeding were older than those without (75.6 vs. 73.4 years; p < 0.01). They were more likely to have pre-existing heart failure (33.7% vs 26.7%; p < 0.01), history of major bleeding (7.7% vs. 4.0%; p < 0.01) and higher mean HAS-BLED score (2.05 vs.1.73; p < 0.01). On landmark analysis, ischaemic stroke or systemic embolism occurred in 17 patients (3.6/100 person-years) after major bleeding and 227 patients (1.7/100 person-years) without major bleeding, with an adjusted hazard ratio (HR) of 1.93 (95% confidence interval [CI], 1.06-3.23; p = 0.03). All-cause mortality occurred in 97 patients with major bleeding (20.0/100 person-years) and 709 (5.1/100 person-years) patients without major bleeding (HR 2.73 [95% CI, 2.16-3.41; p < 0.01]).

CONCLUSION: In this community based cohort, major bleeding is associated with increased risk of subsequent all-cause mortality and thromboembolism in the long-term amongst AF patients.