Oral anticoagulation among atrial fibrillation patients with anaemia: an observational cohort study

Anders Nissen Bonde; Paul Blanche; Laila Stærk; Thomas Alexander Gerds; Anna Gundlund; Gunnar Gislason; Christian Torp-Pedersen; Gregory Y H Lip; Mark A Hlatky; Jonas Bjerring Olesen

doi:10.1093/eurheartj/ehz155

Oral anticoagulation among atrial fibrillation patients with anaemia: an observational cohort study

Anders Nissen Bonde, Paul Blanche, Laila Stærk, Thomas Alexander Gerds, Anna Gundlund, Gunnar Gislason, Christian Torp-Pedersen, Gregory Y H Lip, Mark A Hlatky, Jonas Bjerring Olesen

9 Citations (Scopus)

Abstract

Aims: To investigate the risk of stroke/thromboembolism (TE) and major bleeding associated with anaemia among patients with atrial fibrillation (AF). Also, to assess the effects of oral anticoagulation (OAC) and time in therapeutic range (TTR) with Vitamin K antagonists according to level of haemoglobin (Hb). Methods and results: Through administrative registry databases, we identified all Danish patients diagnosed with AF from 1997 to 2012. We included 18 734 AF patients with recent available data on Hb. Multiple Cox regression analyses were used to estimate hazard ratios and to compute standardized absolute 1-year risks of stroke/TE and major bleeding. Among included patients, 3796 (20%) had mild anaemia (Hb 6.83-7.45 mmol/L for women and Hb 6.83-8.03 mmol/L for men) and 2562 (14%) had moderate/severe anaemia (Hb <6.83 mmol/L). Moderate/severe anaemia was associated with increased risk of major bleeding and 9.1% lower median TTR compared with no anaemia. Use of OAC was associated with reduced risk of stroke/TE among patients without anaemia [standardized absolute 1-year difference-2.5%, 95% confidence interval (CI)-3.8 to-1.7%] or with mild anaemia (-2.3%, 95% CI-2.8 to-1.8%), but not with moderate/severe anaemia, (0.03%,-1.8 to +2.8%, interaction P = 0.01). Oral anticoagulation was associated with a 5.3% (95% CI 2.1-8.7%) increased standardized absolute risk of major bleeding among AF patients with moderate/severe anaemia. Conclusion: Anaemia was common in patients with AF and associated with major bleeding and lower TTR. Oral anticoagulation was associated with more major bleeding, but no reduction in risk of stroke/TE among AF patients with moderate/severe anaemia.

Original language	English
Journal	European Heart Journal
Volume	40
Issue number	46
Pages (from-to)	3782–3790
Number of pages	9
ISSN	0195-668X
DOIs	https://doi.org/10.1093/eurheartj/ehz155
Publication status	Published - 7 Dec 2019

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@article{b2d65957e02d4aaea5fe6c1147d97045,

title = "Oral anticoagulation among atrial fibrillation patients with anaemia: an observational cohort study",

abstract = "Aims: To investigate the risk of stroke/thromboembolism (TE) and major bleeding associated with anaemia among patients with atrial fibrillation (AF). Also, to assess the effects of oral anticoagulation (OAC) and time in therapeutic range (TTR) with Vitamin K antagonists according to level of haemoglobin (Hb). Methods and results: Through administrative registry databases, we identified all Danish patients diagnosed with AF from 1997 to 2012. We included 18 734 AF patients with recent available data on Hb. Multiple Cox regression analyses were used to estimate hazard ratios and to compute standardized absolute 1-year risks of stroke/TE and major bleeding. Among included patients, 3796 (20%) had mild anaemia (Hb 6.83-7.45 mmol/L for women and Hb 6.83-8.03 mmol/L for men) and 2562 (14%) had moderate/severe anaemia (Hb <6.83 mmol/L). Moderate/severe anaemia was associated with increased risk of major bleeding and 9.1% lower median TTR compared with no anaemia. Use of OAC was associated with reduced risk of stroke/TE among patients without anaemia [standardized absolute 1-year difference-2.5%, 95% confidence interval (CI)-3.8 to-1.7%] or with mild anaemia (-2.3%, 95% CI-2.8 to-1.8%), but not with moderate/severe anaemia, (0.03%,-1.8 to +2.8%, interaction P = 0.01). Oral anticoagulation was associated with a 5.3% (95% CI 2.1-8.7%) increased standardized absolute risk of major bleeding among AF patients with moderate/severe anaemia. Conclusion: Anaemia was common in patients with AF and associated with major bleeding and lower TTR. Oral anticoagulation was associated with more major bleeding, but no reduction in risk of stroke/TE among AF patients with moderate/severe anaemia.",

author = "Bonde, {Anders Nissen} and Paul Blanche and Laila St{\ae}rk and Gerds, {Thomas Alexander} and Anna Gundlund and Gunnar Gislason and Christian Torp-Pedersen and Lip, {Gregory Y H} and Hlatky, {Mark A} and Olesen, {Jonas Bjerring}",

year = "2019",

month = dec,

day = "7",

doi = "10.1093/eurheartj/ehz155",

language = "English",

volume = "40",

pages = "3782–3790",

journal = "European Heart Journal",

issn = "0195-668X",

publisher = "Oxford University Press",

number = "46",

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TY - JOUR

T1 - Oral anticoagulation among atrial fibrillation patients with anaemia

T2 - an observational cohort study

AU - Bonde, Anders Nissen

AU - Blanche, Paul

AU - Stærk, Laila

AU - Gerds, Thomas Alexander

AU - Gundlund, Anna

AU - Gislason, Gunnar

AU - Torp-Pedersen, Christian

AU - Lip, Gregory Y H

AU - Hlatky, Mark A

AU - Olesen, Jonas Bjerring

PY - 2019/12/7

Y1 - 2019/12/7

N2 - Aims: To investigate the risk of stroke/thromboembolism (TE) and major bleeding associated with anaemia among patients with atrial fibrillation (AF). Also, to assess the effects of oral anticoagulation (OAC) and time in therapeutic range (TTR) with Vitamin K antagonists according to level of haemoglobin (Hb). Methods and results: Through administrative registry databases, we identified all Danish patients diagnosed with AF from 1997 to 2012. We included 18 734 AF patients with recent available data on Hb. Multiple Cox regression analyses were used to estimate hazard ratios and to compute standardized absolute 1-year risks of stroke/TE and major bleeding. Among included patients, 3796 (20%) had mild anaemia (Hb 6.83-7.45 mmol/L for women and Hb 6.83-8.03 mmol/L for men) and 2562 (14%) had moderate/severe anaemia (Hb <6.83 mmol/L). Moderate/severe anaemia was associated with increased risk of major bleeding and 9.1% lower median TTR compared with no anaemia. Use of OAC was associated with reduced risk of stroke/TE among patients without anaemia [standardized absolute 1-year difference-2.5%, 95% confidence interval (CI)-3.8 to-1.7%] or with mild anaemia (-2.3%, 95% CI-2.8 to-1.8%), but not with moderate/severe anaemia, (0.03%,-1.8 to +2.8%, interaction P = 0.01). Oral anticoagulation was associated with a 5.3% (95% CI 2.1-8.7%) increased standardized absolute risk of major bleeding among AF patients with moderate/severe anaemia. Conclusion: Anaemia was common in patients with AF and associated with major bleeding and lower TTR. Oral anticoagulation was associated with more major bleeding, but no reduction in risk of stroke/TE among AF patients with moderate/severe anaemia.

AB - Aims: To investigate the risk of stroke/thromboembolism (TE) and major bleeding associated with anaemia among patients with atrial fibrillation (AF). Also, to assess the effects of oral anticoagulation (OAC) and time in therapeutic range (TTR) with Vitamin K antagonists according to level of haemoglobin (Hb). Methods and results: Through administrative registry databases, we identified all Danish patients diagnosed with AF from 1997 to 2012. We included 18 734 AF patients with recent available data on Hb. Multiple Cox regression analyses were used to estimate hazard ratios and to compute standardized absolute 1-year risks of stroke/TE and major bleeding. Among included patients, 3796 (20%) had mild anaemia (Hb 6.83-7.45 mmol/L for women and Hb 6.83-8.03 mmol/L for men) and 2562 (14%) had moderate/severe anaemia (Hb <6.83 mmol/L). Moderate/severe anaemia was associated with increased risk of major bleeding and 9.1% lower median TTR compared with no anaemia. Use of OAC was associated with reduced risk of stroke/TE among patients without anaemia [standardized absolute 1-year difference-2.5%, 95% confidence interval (CI)-3.8 to-1.7%] or with mild anaemia (-2.3%, 95% CI-2.8 to-1.8%), but not with moderate/severe anaemia, (0.03%,-1.8 to +2.8%, interaction P = 0.01). Oral anticoagulation was associated with a 5.3% (95% CI 2.1-8.7%) increased standardized absolute risk of major bleeding among AF patients with moderate/severe anaemia. Conclusion: Anaemia was common in patients with AF and associated with major bleeding and lower TTR. Oral anticoagulation was associated with more major bleeding, but no reduction in risk of stroke/TE among AF patients with moderate/severe anaemia.

U2 - 10.1093/eurheartj/ehz155

DO - 10.1093/eurheartj/ehz155

M3 - Journal article

C2 - 30932145

SN - 0195-668X

VL - 40

SP - 3782

EP - 3790

JO - European Heart Journal

JF - European Heart Journal

IS - 46

ER -

Oral anticoagulation among atrial fibrillation patients with anaemia: an observational cohort study

Abstract

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