Abstract WMP102: Risk Factors for MACE and Major Bleeding in Patients With Atrial Fibrillation Undergoing Elective Surgery: Insights From the BRIDGE Randomized Trial

Abstract

Introduction: Atrial fibrillation (AF) patients undergoing elective procedures are at risk for Major Adverse Cardiovascular Events (MACE) and major bleeding. This study aimed to identify risk factors to guide risk stratification and perioperative management. Methods: We performed a post-hoc analysis of the BRIDGE randomized trial. Patients who were randomized into the study with outcome follow-ups were included in the analysis. The primary outcome was MACE (stroke, myocardial infarction, and cardiovascular death) and clinically symptomatic major bleeding. Statistical techniques included standard univariate analysis, logistic stepwise regression, and Cox regression models with Schoenfeld residual test to validate proportional hazard assumption. Additional interaction analyses were performed to assess interactions between low-molecular-weight heparin bridge therapy with identified risk factors. Results: A total of 1,813 participants met inclusion criteria: mean age 71.6±8.8, 73.3% male. MACE occurred in 25 (1.4%) individuals, with pre-procedure clopidogrel use (adjusted hazard ratio [aHR] 7.73, 95% CI 2.63-22.72, p<0.001) and high CHA 2 DS 2 -VASc score (≥ 5; aHR 2.89, 95% CI 1.26-6.63, p=0.012) identified as risk factors. Major bleeding occurred in 41 (2.3%) individuals, with bridge therapy (aHR 2.53, 95% CI 1.29-4.96, p=0.007), history of renal disease (aHR 3.12, 95% CI 1.56-6.24, p=0.001), post-procedure aspirin use (aHR 3.02, 95% CI 1.61-5.68, p=0.001), post-procedure NSAID use (aHR 3.90, 95% CI 1.20-12.70, p=0.024), and major surgery (aHR 2.17, 95% CI 1.05-4.46, p=0.036) identified as risk factors. The interactions between above risk factors and bridge therapy for MACE and major bleeding outcomes were not significant (p>0.05). Conclusion: The importance of perioperative assessment in AF patients is underscored by our findings, which identify distinct predictors for MACE and major bleeding. Guided by these insights, clinicians may generally avoid bridging and concomitant post-operative aspirin and NSAID use, thereby optimizing perioperative management to minimize the risk of adverse outcomes.