CE-539-02 UTILIZATION OF ORAL ANTICOAGULATION AFTER BLEEDING EVENTS IN STROKE PATIENTS WITH ATRIAL FIBRILLATION

Abstract

Oral anticoagulation (OAC) is recommended for stroke prophylaxis after diagnosis of atrial fibrillation (AF). However, the optimal strategy or timing for continuing OAC use after bleeding events in these patients has not been well established. This analysis seeks to characterize real-world patterns of OAC utilization after bleeding events in patients with prior ischemic stroke and diagnosed AF. Patients with a diagnosis code for a bleeding event between 1/01/2007-3/31/2021 were identified in the U.S. de-identified Optum® Clinformatics® claims database. Bleed events were identified based on the presence of an ICD-9/-10 diagnosis code for bleeding in any site of service, and included: hemorrhagic stroke (HS), other intracranial hemorrhage (ICH), or extracranial hemorrhage (ECH). Patients were required to have any prior evidence of AF diagnosis, and must have OAC prescription coverage within the 3 months prior to the index bleed event. Kaplan-Meier curves were created to estimate the rate at which OACs were restarted after index for each bleed type, including all available follow-up time in the database for each patient. A total of 44,207 patients were identified: 7,755 patients with HS, 781 with ICH, and 35,671 with ECH. After HS, an estimated 26% of patients resumed OAC early, within 30 days of the bleed event; 45% restarted later (36% between 30 days-1 year, 9% after 1 year), and the remaining 29% permanently discontinued. Overall, the median time to refill was 3.1 months. After an Other ICH event: 36% resumed early, 42% restarted later (36% within 1 year and 6% after 1 year), and 22% discontinued; median time to refill was 1.9 months. After ECH: 42% resumed early, 48% restarted later (40% within 1 year and 8% beyond 1 year), with 10% discontinuing; median time to refill was 1.4 months. Although the risk-benefit profile of OAC resumption after bleeding events in AF patients has not been definitively characterized to-date, our analysis of a large claims database indicates that resumption of OAC after bleeding is common in clinical practice, with 71%-90% of patients either continuing or restarting after a brief pause. Upcoming randomized trials aim to provide more information in this space and may enable development of a clearer clinical consensus.