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Nuisance Bleeding in Anticoagulated AF Patients
Study Questions:
Are minor bleeding events (nuisance bleeding; NB) in patients with atrial fibrillation (AF) on oral anticoagulants (OACs) associated with OAC discontinuation, major bleeding, and stroke/systemic embolism (SSE)?
Methods:
The authors used a prospective, outpatient registry, ORBIT-AF, to identify 6,771 patients. NB was defined as minor bleeding that did not require medical attention (e.g., bruising, hemorrhoidal bleeding). The authors evaluated the associations between NB and major bleeding and SSE in the 180 days after documentation of NB. Changes in anticoagulation treatment satisfaction after NB were examined descriptively in a subset of patients.
Results:
The median age of the overall population was 75 years; 43% were female. Among 6,771 patients, 1,357 (20%) had documented NB, for an incidence rate of 14.8 events per 100 person-years. More than 95% of patients remained on OAC therapy after the NB event. Overall, 287 (4.3%) patients experienced major bleeding and 64 (1%) had an SSE event during follow-up. NB was not associated with a significant increased risk of major bleeding or with increased SSE risk over 6 months.
Conclusions:
NB is common among AF patients on OAC; however, it was not associated with a higher risk of major bleeding or SSE.
Perspective:
A minor bleeding is likely to cause anxiety for the patient, and perhaps a rationale to discontinue anticoagulation due to the heightened perception of the bleeding risk. The current report provides physicians with arguments in favor of continuing anticoagulation, as the minor NB does not presage major bleeding during follow-up.
Keywords: Arrhythmias, Cardiac, Anticoagulants, Atrial Fibrillation, Embolism, Heart Failure, Hemorrhage, Geriatrics, Risk, Secondary Prevention, Stroke
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