Life-Time Bleeding Events among Stroke Patients with Atrial Fibrillation during Warfarin Treatment: A Population-Based Cohort Study (IN2-2.004)

Abstract

Objective: We sought to determine the life-long risks of major and fatal bleeding in a population-based cohort of stroke patients with AF undergoing warfarin treatment. Background The widespread use of warfarin is limited by the potential risk of severe bleeding, yet few data are available on the long-term bleeding risk of stroke patients undergoing warfarin treatment for atrial fibrillation (AF). Design/Methods: The resources of the Rochester Epidemiology Project Medical Linkage System were used to identify acute ischemic stroke patients with atrial fibrillation undergoing warfarin treatment from 1980 to 1995. Major bleeding was considered in patients with fatal or clinically overt bleeding associated with either transfusion of >2 units of blood or >2 g/dl decrease in hemoglobin. Results: One hundred patients (mean age, 79.3 years; 68% women) were prescribed warfarin 4 days (median) following stroke onset in the setting of atrial fibrillation. Follow-up data from stroke onset to death was complete in 99 (99%) patients. The median duration of warfarin treatment was 2.4 years (interquartile range, 0.4-6.6) and the median duration from stroke onset to death was 3.7 years (1.1-8.8). Major bleeding events occurred in 41 patients during warfarin treatment at a median duration of 19 months (5-58) following warfarin initiation. These events included intracranial hemorrhage (n=9), gastrointestinal tract bleeding (upper, n=14; lower, n=8), gross hematuria (n=4), gluteal/thigh hematoma (n=4), retroperitoneal (n=1) and pulmonary hemorrhage (n=1). Seven patients died within a week of these bleeding events. Patients with a history of previous hemorrhage prior to warfarin treatment were more likely to develop major hemorrhage compared to those who did not (15% vs 3%, p=0.041). Conclusions: In our cohort, 4 of every 10 patients had at least one episode of major bleeding while on warfarin. Thus, the risk-benefit of warfarin needs to be carefully reassessed over time. Disclosure: Dr. Seet has nothing to disclose. Dr. Rabinstein has received personal compensation for activities with Elsevier as a section editor.Dr. Rabinstein has received research support from Cardionet. Dr. Christianson has nothing to disclose. Dr. Petty has nothing to disclose. Dr. Brown has nothing to disclose.