Hemorrhage in patients under oral anticoagulation for atrial fibrillation. The other side of the coin

Abstract

Introduction and objectivesOral anticoagulation therapy is prescribed to most patients with atrial fibrillation. The main limitation of anticoagulant treatment is the occurrence of bleeding episodes. We sought to assess the type of hemorrhages and mortality in patients anticoagulated for nonvalvular atrial fibrillation. MethodsObservational retrospective study analyzing 2081138 hospitalization reports from 2014 corresponding to 151 hospitals of the Spanish National Health System. Patients were selected with the diagnosis of hemorrhage, nonvalvular atrial fibrillation, and oral anticoagulation. ResultsA total of 5783 hospitalizations were analyzed. Most hemorrhages were digestive (43.6%), followed by cerebral (30.6%). Among the digestive, only 27% were high. Mean age was 79.8 years, 57.1% were males, the mean hospital stay was 7.7 days. Complexity assessed by the mean diagnostic related group was 2.39 (versus 1.83 of the total hospitalizations). In-hospital mortality was 15.2% versus 10.8% of the hospitalization for hemorrhages and 3.9% of the total hospitalizations (P<.05). ConclusionsHemorrhages in patients anticoagulated for nonvalvular atrial fibrillation have a high sociosanitary impact. The most frequent hemorrhages were digestive, only a fourth part of them was high. A third of hemorrhages were cerebral. In-hospital mortality in this population was high.