Oral anticoagulation among atrial fibrillation patients with anaemia: an observational cohort study

Anders Nissen Bonde, Paul Blanche, Laila Staerk, Thomas Alexander Gerds, Anna Gundlund, Gunnar Gislason, Christian Torp-Pedersen, Gregory Y H Lip, Mark A Hlatky, Jonas Bjerring Olesen

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

AIMS: To investigate the risk of stroke/thromboembolism (TE) and major bleeding associated with anaemia among patients with atrial fibrillation (AF). Also, to assess the effects of oral anticoagulation (OAC) and time in therapeutic range (TTR) with vitamin K antagonists according to level of haemoglobin (Hb).

METHODS AND RESULTS: Through administrative registry databases, we identified all Danish patients diagnosed with AF from 1997 to 2012. We included 18 734 AF patients with recent available data on Hb. Multiple Cox regression analyses were used to estimate hazard ratios and to compute standardized absolute 1-year risks of stroke/TE and major bleeding. Among included patients, 3796 (20%) had mild anaemia (Hb 6.83-7.45 mmol/L for women and Hb 6.83-8.03 mmol/L for men) and 2562 (14%) had moderate/severe anaemia (Hb <6.83 mmol/L). Moderate/severe anaemia was associated with increased risk of major bleeding and 9.1% lower median TTR compared with no anaemia. Use of OAC was associated with reduced risk of stroke/TE among patients without anaemia [standardized absolute 1-year difference -2.5%, 95% confidence interval (CI) -3.8 to -1.7%] or with mild anaemia (-2.3%, 95% CI -2.8 to -1.8%), but not with moderate/severe anaemia, (0.03%, -1.8 to +2.8%, interaction P = 0.01). Oral anticoagulation was associated with a 5.3% (95% CI 2.1-8.7%) increased standardized absolute risk of major bleeding among AF patients with moderate/severe anaemia.

CONCLUSION: Anaemia was common in patients with AF and associated with major bleeding and lower TTR. Oral anticoagulation was associated with more major bleeding, but no reduction in risk of stroke/TE among AF patients with moderate/severe anaemia.

OriginalsprogEngelsk
TidsskriftEuropean Heart Journal
ISSN0195-668X
DOI
StatusE-pub ahead of print - 1 apr. 2019

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Atrial Fibrillation
Observational Studies
Anemia
Cohort Studies
Thromboembolism
Hemorrhage
Hemoglobins
Stroke
Confidence Intervals
Vitamin K
Risk Reduction Behavior
Registries
Therapeutics
Regression Analysis
Databases

Citer dette

Bonde, A. N., Blanche, P., Staerk, L., Gerds, T. A., Gundlund, A., Gislason, G., ... Olesen, J. B. (2019). Oral anticoagulation among atrial fibrillation patients with anaemia: an observational cohort study. European Heart Journal. https://doi.org/10.1093/eurheartj/ehz155
Bonde, Anders Nissen ; Blanche, Paul ; Staerk, Laila ; Gerds, Thomas Alexander ; Gundlund, Anna ; Gislason, Gunnar ; Torp-Pedersen, Christian ; Lip, Gregory Y H ; Hlatky, Mark A ; Olesen, Jonas Bjerring. / Oral anticoagulation among atrial fibrillation patients with anaemia : an observational cohort study. I: European Heart Journal. 2019.
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title = "Oral anticoagulation among atrial fibrillation patients with anaemia: an observational cohort study",
abstract = "AIMS: To investigate the risk of stroke/thromboembolism (TE) and major bleeding associated with anaemia among patients with atrial fibrillation (AF). Also, to assess the effects of oral anticoagulation (OAC) and time in therapeutic range (TTR) with vitamin K antagonists according to level of haemoglobin (Hb).METHODS AND RESULTS: Through administrative registry databases, we identified all Danish patients diagnosed with AF from 1997 to 2012. We included 18 734 AF patients with recent available data on Hb. Multiple Cox regression analyses were used to estimate hazard ratios and to compute standardized absolute 1-year risks of stroke/TE and major bleeding. Among included patients, 3796 (20{\%}) had mild anaemia (Hb 6.83-7.45 mmol/L for women and Hb 6.83-8.03 mmol/L for men) and 2562 (14{\%}) had moderate/severe anaemia (Hb <6.83 mmol/L). Moderate/severe anaemia was associated with increased risk of major bleeding and 9.1{\%} lower median TTR compared with no anaemia. Use of OAC was associated with reduced risk of stroke/TE among patients without anaemia [standardized absolute 1-year difference -2.5{\%}, 95{\%} confidence interval (CI) -3.8 to -1.7{\%}] or with mild anaemia (-2.3{\%}, 95{\%} CI -2.8 to -1.8{\%}), but not with moderate/severe anaemia, (0.03{\%}, -1.8 to +2.8{\%}, interaction P = 0.01). Oral anticoagulation was associated with a 5.3{\%} (95{\%} CI 2.1-8.7{\%}) increased standardized absolute risk of major bleeding among AF patients with moderate/severe anaemia.CONCLUSION: Anaemia was common in patients with AF and associated with major bleeding and lower TTR. Oral anticoagulation was associated with more major bleeding, but no reduction in risk of stroke/TE among AF patients with moderate/severe anaemia.",
author = "Bonde, {Anders Nissen} and Paul Blanche and Laila Staerk and Gerds, {Thomas Alexander} and Anna Gundlund and Gunnar Gislason and Christian Torp-Pedersen and Lip, {Gregory Y H} and Hlatky, {Mark A} and Olesen, {Jonas Bjerring}",
note = "Published on behalf of the European Society of Cardiology. All rights reserved. {\circledC} The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.",
year = "2019",
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doi = "10.1093/eurheartj/ehz155",
language = "English",
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Oral anticoagulation among atrial fibrillation patients with anaemia : an observational cohort study. / Bonde, Anders Nissen; Blanche, Paul; Staerk, Laila; Gerds, Thomas Alexander; Gundlund, Anna; Gislason, Gunnar; Torp-Pedersen, Christian; Lip, Gregory Y H; Hlatky, Mark A; Olesen, Jonas Bjerring.

I: European Heart Journal, 01.04.2019.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Oral anticoagulation among atrial fibrillation patients with anaemia

T2 - an observational cohort study

AU - Bonde, Anders Nissen

AU - Blanche, Paul

AU - Staerk, Laila

AU - Gerds, Thomas Alexander

AU - Gundlund, Anna

AU - Gislason, Gunnar

AU - Torp-Pedersen, Christian

AU - Lip, Gregory Y H

AU - Hlatky, Mark A

AU - Olesen, Jonas Bjerring

N1 - Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.

PY - 2019/4/1

Y1 - 2019/4/1

N2 - AIMS: To investigate the risk of stroke/thromboembolism (TE) and major bleeding associated with anaemia among patients with atrial fibrillation (AF). Also, to assess the effects of oral anticoagulation (OAC) and time in therapeutic range (TTR) with vitamin K antagonists according to level of haemoglobin (Hb).METHODS AND RESULTS: Through administrative registry databases, we identified all Danish patients diagnosed with AF from 1997 to 2012. We included 18 734 AF patients with recent available data on Hb. Multiple Cox regression analyses were used to estimate hazard ratios and to compute standardized absolute 1-year risks of stroke/TE and major bleeding. Among included patients, 3796 (20%) had mild anaemia (Hb 6.83-7.45 mmol/L for women and Hb 6.83-8.03 mmol/L for men) and 2562 (14%) had moderate/severe anaemia (Hb <6.83 mmol/L). Moderate/severe anaemia was associated with increased risk of major bleeding and 9.1% lower median TTR compared with no anaemia. Use of OAC was associated with reduced risk of stroke/TE among patients without anaemia [standardized absolute 1-year difference -2.5%, 95% confidence interval (CI) -3.8 to -1.7%] or with mild anaemia (-2.3%, 95% CI -2.8 to -1.8%), but not with moderate/severe anaemia, (0.03%, -1.8 to +2.8%, interaction P = 0.01). Oral anticoagulation was associated with a 5.3% (95% CI 2.1-8.7%) increased standardized absolute risk of major bleeding among AF patients with moderate/severe anaemia.CONCLUSION: Anaemia was common in patients with AF and associated with major bleeding and lower TTR. Oral anticoagulation was associated with more major bleeding, but no reduction in risk of stroke/TE among AF patients with moderate/severe anaemia.

AB - AIMS: To investigate the risk of stroke/thromboembolism (TE) and major bleeding associated with anaemia among patients with atrial fibrillation (AF). Also, to assess the effects of oral anticoagulation (OAC) and time in therapeutic range (TTR) with vitamin K antagonists according to level of haemoglobin (Hb).METHODS AND RESULTS: Through administrative registry databases, we identified all Danish patients diagnosed with AF from 1997 to 2012. We included 18 734 AF patients with recent available data on Hb. Multiple Cox regression analyses were used to estimate hazard ratios and to compute standardized absolute 1-year risks of stroke/TE and major bleeding. Among included patients, 3796 (20%) had mild anaemia (Hb 6.83-7.45 mmol/L for women and Hb 6.83-8.03 mmol/L for men) and 2562 (14%) had moderate/severe anaemia (Hb <6.83 mmol/L). Moderate/severe anaemia was associated with increased risk of major bleeding and 9.1% lower median TTR compared with no anaemia. Use of OAC was associated with reduced risk of stroke/TE among patients without anaemia [standardized absolute 1-year difference -2.5%, 95% confidence interval (CI) -3.8 to -1.7%] or with mild anaemia (-2.3%, 95% CI -2.8 to -1.8%), but not with moderate/severe anaemia, (0.03%, -1.8 to +2.8%, interaction P = 0.01). Oral anticoagulation was associated with a 5.3% (95% CI 2.1-8.7%) increased standardized absolute risk of major bleeding among AF patients with moderate/severe anaemia.CONCLUSION: Anaemia was common in patients with AF and associated with major bleeding and lower TTR. Oral anticoagulation was associated with more major bleeding, but no reduction in risk of stroke/TE among AF patients with moderate/severe anaemia.

U2 - 10.1093/eurheartj/ehz155

DO - 10.1093/eurheartj/ehz155

M3 - Journal article

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

ER -