TY - JOUR
T1 - Oral Anticoagulant Use for Patients with Atrial Fibrillation with Concomitant Anemia and/or Thrombocytopenia
AU - Yeh, Yung-Hsin
AU - Chan, Yi-Hsin
AU - Chen, Shao-Wei
AU - Chang, Shang-Hung
AU - Wang, Chun-Li
AU - Kuo, Chi-Tai
AU - Lip, Gregory Y. H.
AU - Chen, Shih-Ann
AU - Chao, Tze-Fan
N1 - Copyright © 2022 Elsevier Inc. All rights reserved.
PY - 2022/8
Y1 - 2022/8
N2 - OBJECTIVE: Hemoglobin levels and platelet counts have been associated with adverse clinical outcomes in patients with cardiovascular conditions. We aimed to assess the impact of oral anticoagulant use for patients with atrial fibrillation and concomitant anemia or thrombocytopenia.METHODS: We used medical data from a multicenter health care system in Taiwan including 37,074 patients with atrial fibrillation. Patients were categorized into 3 groups based on hemoglobin and platelet levels: Group 1 (hemoglobin >10g/dL and platelet>100 K/µL; n = 29,147), Group 2 (hemoglobin<10 g/dL or platelet<100 K/µL; n = 7078), and Group 3 (hemoglobin <10 g/dL and platelet <100 K/µL; n = 849). Patients in each category were further stratified as 3 groups according to their stroke prevention strategies: no oral anticoagulant use (non-OAC), warfarin, or nonvitamin K antagonist oral anticoagulants (NOACs).RESULTS: A higher hemoglobin or platelet level was associated with a higher risk of ischemic stroke/systemic embolism but lower risks of intracranial hemorrhage and major bleeding. The composite risks of ischemic stroke/systemic embolism, intracranial hemorrhage and major bleeding were higher in Group 3 or Group 2, compared with Group 1 (6.79% a year vs 6.41% year vs 4.13% year). Compared to non-OACs, warfarin was not associated with a lower composite risk in the 3 groups. NOACs were associated with a lower composite risk in Group 1 (adjusted hazard ratio:0.68, [95% confidence interval:0.60-0.76]) and Group 2 (adjusted hazard ratio:0.73, [95% confidence interval:0.53-0.99]) but was nonsignificant in Group 3.CONCLUSIONS: Patients with atrial fibrillation with anemia or thrombocytopenia were a high-risk population. Compared with no OAC use, NOACs were associated with better clinical outcomes for patients with atrial fibrillation and advanced anemia (hemoglobin <10g/dL) or thrombocytopenia (platelet <100 K/µL) but not for those with both conditions.
AB - OBJECTIVE: Hemoglobin levels and platelet counts have been associated with adverse clinical outcomes in patients with cardiovascular conditions. We aimed to assess the impact of oral anticoagulant use for patients with atrial fibrillation and concomitant anemia or thrombocytopenia.METHODS: We used medical data from a multicenter health care system in Taiwan including 37,074 patients with atrial fibrillation. Patients were categorized into 3 groups based on hemoglobin and platelet levels: Group 1 (hemoglobin >10g/dL and platelet>100 K/µL; n = 29,147), Group 2 (hemoglobin<10 g/dL or platelet<100 K/µL; n = 7078), and Group 3 (hemoglobin <10 g/dL and platelet <100 K/µL; n = 849). Patients in each category were further stratified as 3 groups according to their stroke prevention strategies: no oral anticoagulant use (non-OAC), warfarin, or nonvitamin K antagonist oral anticoagulants (NOACs).RESULTS: A higher hemoglobin or platelet level was associated with a higher risk of ischemic stroke/systemic embolism but lower risks of intracranial hemorrhage and major bleeding. The composite risks of ischemic stroke/systemic embolism, intracranial hemorrhage and major bleeding were higher in Group 3 or Group 2, compared with Group 1 (6.79% a year vs 6.41% year vs 4.13% year). Compared to non-OACs, warfarin was not associated with a lower composite risk in the 3 groups. NOACs were associated with a lower composite risk in Group 1 (adjusted hazard ratio:0.68, [95% confidence interval:0.60-0.76]) and Group 2 (adjusted hazard ratio:0.73, [95% confidence interval:0.53-0.99]) but was nonsignificant in Group 3.CONCLUSIONS: Patients with atrial fibrillation with anemia or thrombocytopenia were a high-risk population. Compared with no OAC use, NOACs were associated with better clinical outcomes for patients with atrial fibrillation and advanced anemia (hemoglobin <10g/dL) or thrombocytopenia (platelet <100 K/µL) but not for those with both conditions.
KW - Anemia
KW - Atrial fibrillation
KW - Hemoglobin
KW - NOACs
KW - Platelet
KW - Thrombocytopenia
KW - Warfarin
KW - Embolism/complications
KW - Administration, Oral
KW - Thrombocytopenia/chemically induced
KW - Humans
KW - Risk Factors
KW - Stroke/drug therapy
KW - Intracranial Hemorrhages/chemically induced
KW - Hemorrhage/epidemiology
KW - Anticoagulants/therapeutic use
KW - Ischemic Stroke
KW - Anemia/complications
KW - Warfarin/therapeutic use
KW - Atrial Fibrillation/complications
KW - Hemoglobins
UR - http://www.scopus.com/inward/record.url?scp=85129687152&partnerID=8YFLogxK
U2 - 10.1016/j.amjmed.2022.03.011
DO - 10.1016/j.amjmed.2022.03.011
M3 - Journal article
C2 - 35381212
SN - 0002-9343
VL - 135
SP - e248-e256
JO - The American Journal of Medicine
JF - The American Journal of Medicine
IS - 8
ER -