Adverse events in clinically complex elderly patients with atrial fibrillation according to oral anticoagulation statusResearch in context
Summary: Background: Few data are available about the impact of oral anticoagulants (OAC) in patients with Atrial Fibrillation (AF) and clinical complexity (CC). Methods: We conducted a retrospective study utilising data from the TriNetX network. Based on ICD-10-CM codes entered between 2020 and 20...
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Elsevier
2024-12-01
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| author | Tommaso Bucci Giulio Francesco Romiti Hironori Ishiguchi Luigi Gerra Marta Mantovani Bi Huang Marco Proietti Gregory Y.H. Lip |
| author_facet | Tommaso Bucci Giulio Francesco Romiti Hironori Ishiguchi Luigi Gerra Marta Mantovani Bi Huang Marco Proietti Gregory Y.H. Lip |
| author_sort | Tommaso Bucci |
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| description | Summary: Background: Few data are available about the impact of oral anticoagulants (OAC) in patients with Atrial Fibrillation (AF) and clinical complexity (CC). Methods: We conducted a retrospective study utilising data from the TriNetX network. Based on ICD-10-CM codes entered between 2020 and 2022, AF patients aged ≥75 years on long-term OAC with CC were categorised into two groups based on OAC use in the year before entering the study (maintained vs discontinued). CC was defined as BMI ≤23 kg/m2, and/or history of bleeding, and/or chronic kidney disease. The primary outcomes were the one-year risk of all-cause death, major cardiovascular events (MACE), and major bleeding. Cox regression analyses were used to calculate hazard ratios (HRs) and 95% CIs before and after 1:1 propensity score matching (PSM). Findings: We identified 6554 AF CC patients who discontinued OAC (mean age 81.5 ± 6.0 years, 46.7% females) and 23,212 AF patients with CC who maintained OAC (81.3 ± 6.0 years, 49.4% females). Before PSM, AF CC patients who discontinued OAC had a higher prevalence of intracranial, gastrointestinal haemorrhages, and antiplatelet use, with no significant differences after PSM. OAC discontinuation was associated with a higher risk of all-cause death (HR 1.22, 95% CI 1.11–1.35) and MACE (HR 1.38, 95% CI 1.25–1.53). The one-year risk of major bleeding was similar in those who discontinued or maintained OAC (HR 1.05, 95% CI 0.94–1.18), although it was significantly higher during the early follow-up (HR 1.51, 95% CI 1.24–1.83). The risk of primary outcomes decreased over time, with the risk of bleeding becoming not significant. Interpretation: AF CC patients who discontinued OAC have a high risk of adverse events. New antithrombotic and integrated care approaches to reduce thrombotic risk without increasing bleeding risk are needed in these patients. Funding: This study received no funding. |
| format | Article |
| id | doaj-art-8c2ac6ce8bc145d88e86815b3f8734ed |
| institution | DOAJ |
| issn | 2589-5370 |
| language | English |
| publishDate | 2024-12-01 |
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| spelling | doaj-art-8c2ac6ce8bc145d88e86815b3f8734ed2025-08-20T02:51:14ZengElsevierEClinicalMedicine2589-53702024-12-017810297410.1016/j.eclinm.2024.102974Adverse events in clinically complex elderly patients with atrial fibrillation according to oral anticoagulation statusResearch in contextTommaso Bucci0Giulio Francesco Romiti1Hironori Ishiguchi2Luigi Gerra3Marta Mantovani4Bi Huang5Marco Proietti6Gregory Y.H. Lip7Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, Liverpool, United Kingdom; Department of Clinical Internal, Anaesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy; Corresponding author. Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, Liverpool, United Kingdom.Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, Liverpool, United Kingdom; Department of Translational and Precision Medicine, Sapienza, University of Rome, Rome, ItalyLiverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, Liverpool, United Kingdom; Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, JapanLiverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, Liverpool, United Kingdom; Cardiology Division Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, ItalyLiverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, Liverpool, United Kingdom; Cardiology Division Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, ItalyLiverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, Liverpool, United Kingdom; Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, ChinaDepartment of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan, ItalyLiverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, Liverpool, United Kingdom; Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Corresponding author. Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, Liverpool, United Kingdom.Summary: Background: Few data are available about the impact of oral anticoagulants (OAC) in patients with Atrial Fibrillation (AF) and clinical complexity (CC). Methods: We conducted a retrospective study utilising data from the TriNetX network. Based on ICD-10-CM codes entered between 2020 and 2022, AF patients aged ≥75 years on long-term OAC with CC were categorised into two groups based on OAC use in the year before entering the study (maintained vs discontinued). CC was defined as BMI ≤23 kg/m2, and/or history of bleeding, and/or chronic kidney disease. The primary outcomes were the one-year risk of all-cause death, major cardiovascular events (MACE), and major bleeding. Cox regression analyses were used to calculate hazard ratios (HRs) and 95% CIs before and after 1:1 propensity score matching (PSM). Findings: We identified 6554 AF CC patients who discontinued OAC (mean age 81.5 ± 6.0 years, 46.7% females) and 23,212 AF patients with CC who maintained OAC (81.3 ± 6.0 years, 49.4% females). Before PSM, AF CC patients who discontinued OAC had a higher prevalence of intracranial, gastrointestinal haemorrhages, and antiplatelet use, with no significant differences after PSM. OAC discontinuation was associated with a higher risk of all-cause death (HR 1.22, 95% CI 1.11–1.35) and MACE (HR 1.38, 95% CI 1.25–1.53). The one-year risk of major bleeding was similar in those who discontinued or maintained OAC (HR 1.05, 95% CI 0.94–1.18), although it was significantly higher during the early follow-up (HR 1.51, 95% CI 1.24–1.83). The risk of primary outcomes decreased over time, with the risk of bleeding becoming not significant. Interpretation: AF CC patients who discontinued OAC have a high risk of adverse events. New antithrombotic and integrated care approaches to reduce thrombotic risk without increasing bleeding risk are needed in these patients. Funding: This study received no funding.http://www.sciencedirect.com/science/article/pii/S2589537024005534Atrial fibrillationClinical complexityAnticoagulantsBleedingThromboembolism |
| spellingShingle | Tommaso Bucci Giulio Francesco Romiti Hironori Ishiguchi Luigi Gerra Marta Mantovani Bi Huang Marco Proietti Gregory Y.H. Lip Adverse events in clinically complex elderly patients with atrial fibrillation according to oral anticoagulation statusResearch in context EClinicalMedicine Atrial fibrillation Clinical complexity Anticoagulants Bleeding Thromboembolism |
| title | Adverse events in clinically complex elderly patients with atrial fibrillation according to oral anticoagulation statusResearch in context |
| title_full | Adverse events in clinically complex elderly patients with atrial fibrillation according to oral anticoagulation statusResearch in context |
| title_fullStr | Adverse events in clinically complex elderly patients with atrial fibrillation according to oral anticoagulation statusResearch in context |
| title_full_unstemmed | Adverse events in clinically complex elderly patients with atrial fibrillation according to oral anticoagulation statusResearch in context |
| title_short | Adverse events in clinically complex elderly patients with atrial fibrillation according to oral anticoagulation statusResearch in context |
| title_sort | adverse events in clinically complex elderly patients with atrial fibrillation according to oral anticoagulation statusresearch in context |
| topic | Atrial fibrillation Clinical complexity Anticoagulants Bleeding Thromboembolism |
| url | http://www.sciencedirect.com/science/article/pii/S2589537024005534 |
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