Abstract 11512: Association Between Use of Oral Anticoagulants After Minor Bleeding and Mortality Outcomes in Patients With Atrial Fibrillation: The Fushimi AF Registry

Abstract

Introduction: Oral anticoagulants (OAC) reduce the risk of ischemic stroke, but may increase the risk of major or minor bleeding in atrial fibrillation (AF) patients. However, little is known about the management of anticoagulation in patients with AF after a minor bleeding event. This study assessed the association between use of OAC and outcomes in AF patients after minor bleeding. Methods: The Fushimi AF Registry is a community-based prospective survey of the AF patients in Fushimi-ku, Kyoto, Japan. A total cohort of 4,489 AF patients were analyzed in the present study. We investigated patients in whom minor bleeding occurred during follow-up period, and compared between patients with OAC and those without OAC after minor bleeding. Results: During the median follow-up period of 1,844 days, minor bleeding occurred in 744 patients (5.7% per patient-year). After excluding patients with missing prescription data after minor bleeding, 494 patients were prescribed OAC and 234 were not prescribed after minor bleeding. Patients with OAC were more often non-paroxysmal type of AF (27.4% vs 48.0%, p<0.01), and were more likely to have previous thromboembolism (23.3% vs 11.5%, p<0.01) and heart failure (29.4% vs 19.2%, p<0.01). They had significantly higher CHADS2 score (2.11 vs 1.79, p<0.01). They were less likely to have history of major bleeding (2.6% vs 5.6%, p<0.05). All-cause mortality after minor bleeding occurred in 91 patients with OAC (4.5% per patient-year) and 62 (7.5% per patient-year) patients without OAC with hazard ratio (HR) 0.62 (95% confidence interval [CI], 0.45-0.86; p<0.01). After adjusted by age, sex, type of AF, and comorbidities, patients with OAC after minor bleeding were significantly associated with lower incidence of all-cause mortality (HR 0.52 [95% CI, 0.37-0.73; p<0.01]). Conclusions: Conclusion: Use of OAC after minor bleeding was significantly associated with lower incidence of all-cause mortality in Japanese AF patients.