Anemia is associated with bleeding and mortality, but not stroke, in patients with atrial fibrillation: Insights from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial

B. Daan Westenbrink; Marco Alings; Christopher B. Granger; John H. Alexander; Renato D. Lopes; Elaine M. Hylek; Laine Thomas; Daniel M. Wojdyla; Michael Hanna; Matyas Keltai; P. Gabriel Steg; Raffaele De Caterina; Lars Wallentin; Wiek H. van Gilst

doi:10.1016/j.ahj.2016.12.008

Anemia is associated with bleeding and mortality, but not stroke, in patients with atrial fibrillation: Insights from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial

B. Daan Westenbrink^*, Marco Alings, Christopher B. Granger, John H. Alexander, Renato D. Lopes, Elaine M. Hylek, Laine Thomas, Daniel M. Wojdyla, Michael Hanna, Matyas Keltai, P. Gabriel Steg, Raffaele De Caterina, Lars Wallentin, Wiek H. van Gilst

^*Corresponding author for this work

Cardiovascular Centre (CVC)

Research output: Contribution to journal › Article › Academic › peer-review

63 Citations (Scopus)

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Abstract

Background Patients with atrial fibrillation (AF) are prone to cardiovascular events and anticoagulation-related bleeding complications. We hypothesized that patients with anemia are at increased risk for these outcomes.

Methods We performed a post hoc analysis of the ARISTOTLE trial, which included >18,000 patients with AF randomized to warfarin (target international normalized ratio, 2.0-3.0) or apixaban 5 mg twice daily. Multivariable Cox regression analysis was used to determine if anemia (defined as hemoglobin

Results Anemia was present at baseline in 12.6% of the ARISTOTLE population. Patients with anemia were older, had higher mean CHADS2 and HAS-BLED scores, and were more likely to have experienced previous bleeding events. Anemia was associated with major bleeding (adjusted hazard ratio [HR], 1.92; 95% CI, 1.62-2.28; P <.0001) and all-cause mortality (adjusted HR, 1.68; 95% CI, 1.46-1.93; P

Conclusions Chronic anemia is associated with a higher incidence of bleeding complications and mortality, but not of stroke, in anticoagulated patients with AF. Apixaban is an attractive anticoagulant for stroke prevention in patients with AF with or without anemia.

Original language	English
Pages (from-to)	140-149
Number of pages	10
Journal	American Heart Journal
Volume	185
DOIs	https://doi.org/10.1016/j.ahj.2016.12.008
Publication status	Published - Mar-2017

Keywords

RISK-PREDICTION SCORES
NET CLINICAL BENEFIT
ANTITHROMBOTIC THERAPY
PREVENT STROKE
WARFARIN
ANTICOAGULATION
METAANALYSIS
PERFORMANCE
MANAGEMENT
HEMORR(2)HAGES

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Westenbrink, B. D., Alings, M., Granger, C. B., Alexander, J. H., Lopes, R. D., Hylek, E. M., Thomas, L., Wojdyla, D. M., Hanna, M., Keltai, M., Steg, P. G., De Caterina, R., Wallentin, L., & van Gilst, W. H. (2017). Anemia is associated with bleeding and mortality, but not stroke, in patients with atrial fibrillation: Insights from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial. American Heart Journal, 185, 140-149. https://doi.org/10.1016/j.ahj.2016.12.008

@article{447af19256064162b90fd5487f07f37f,

title = "Anemia is associated with bleeding and mortality, but not stroke, in patients with atrial fibrillation: Insights from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial",

abstract = "Background Patients with atrial fibrillation (AF) are prone to cardiovascular events and anticoagulation-related bleeding complications. We hypothesized that patients with anemia are at increased risk for these outcomes.Methods We performed a post hoc analysis of the ARISTOTLE trial, which included >18,000 patients with AF randomized to warfarin (target international normalized ratio, 2.0-3.0) or apixaban 5 mg twice daily. Multivariable Cox regression analysis was used to determine if anemia (defined as hemoglobinResults Anemia was present at baseline in 12.6% of the ARISTOTLE population. Patients with anemia were older, had higher mean CHADS2 and HAS-BLED scores, and were more likely to have experienced previous bleeding events. Anemia was associated with major bleeding (adjusted hazard ratio [HR], 1.92; 95% CI, 1.62-2.28; P <.0001) and all-cause mortality (adjusted HR, 1.68; 95% CI, 1.46-1.93; PConclusions Chronic anemia is associated with a higher incidence of bleeding complications and mortality, but not of stroke, in anticoagulated patients with AF. Apixaban is an attractive anticoagulant for stroke prevention in patients with AF with or without anemia.",

keywords = "RISK-PREDICTION SCORES, NET CLINICAL BENEFIT, ANTITHROMBOTIC THERAPY, PREVENT STROKE, WARFARIN, ANTICOAGULATION, METAANALYSIS, PERFORMANCE, MANAGEMENT, HEMORR(2)HAGES",

author = "Westenbrink, {B. Daan} and Marco Alings and Granger, {Christopher B.} and Alexander, {John H.} and Lopes, {Renato D.} and Hylek, {Elaine M.} and Laine Thomas and Wojdyla, {Daniel M.} and Michael Hanna and Matyas Keltai and Steg, {P. Gabriel} and {De Caterina}, Raffaele and Lars Wallentin and {van Gilst}, {Wiek H.}",

year = "2017",

month = mar,

doi = "10.1016/j.ahj.2016.12.008",

language = "English",

volume = "185",

pages = "140--149",

journal = "American Heart Journal",

issn = "0002-8703",

publisher = "MOSBY-ELSEVIER",

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Westenbrink, BD, Alings, M, Granger, CB, Alexander, JH, Lopes, RD, Hylek, EM, Thomas, L, Wojdyla, DM, Hanna, M, Keltai, M, Steg, PG, De Caterina, R, Wallentin, L & van Gilst, WH 2017, 'Anemia is associated with bleeding and mortality, but not stroke, in patients with atrial fibrillation: Insights from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial', American Heart Journal, vol. 185, pp. 140-149. https://doi.org/10.1016/j.ahj.2016.12.008

Anemia is associated with bleeding and mortality, but not stroke, in patients with atrial fibrillation: Insights from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial. / Westenbrink, B. Daan; Alings, Marco; Granger, Christopher B. et al.
In: American Heart Journal, Vol. 185, 03.2017, p. 140-149.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Anemia is associated with bleeding and mortality, but not stroke, in patients with atrial fibrillation

T2 - Insights from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial

AU - Westenbrink, B. Daan

AU - Alings, Marco

AU - Granger, Christopher B.

AU - Alexander, John H.

AU - Lopes, Renato D.

AU - Hylek, Elaine M.

AU - Thomas, Laine

AU - Wojdyla, Daniel M.

AU - Hanna, Michael

AU - Keltai, Matyas

AU - Steg, P. Gabriel

AU - De Caterina, Raffaele

AU - Wallentin, Lars

AU - van Gilst, Wiek H.

PY - 2017/3

Y1 - 2017/3

N2 - Background Patients with atrial fibrillation (AF) are prone to cardiovascular events and anticoagulation-related bleeding complications. We hypothesized that patients with anemia are at increased risk for these outcomes.Methods We performed a post hoc analysis of the ARISTOTLE trial, which included >18,000 patients with AF randomized to warfarin (target international normalized ratio, 2.0-3.0) or apixaban 5 mg twice daily. Multivariable Cox regression analysis was used to determine if anemia (defined as hemoglobinResults Anemia was present at baseline in 12.6% of the ARISTOTLE population. Patients with anemia were older, had higher mean CHADS2 and HAS-BLED scores, and were more likely to have experienced previous bleeding events. Anemia was associated with major bleeding (adjusted hazard ratio [HR], 1.92; 95% CI, 1.62-2.28; P <.0001) and all-cause mortality (adjusted HR, 1.68; 95% CI, 1.46-1.93; PConclusions Chronic anemia is associated with a higher incidence of bleeding complications and mortality, but not of stroke, in anticoagulated patients with AF. Apixaban is an attractive anticoagulant for stroke prevention in patients with AF with or without anemia.

AB - Background Patients with atrial fibrillation (AF) are prone to cardiovascular events and anticoagulation-related bleeding complications. We hypothesized that patients with anemia are at increased risk for these outcomes.Methods We performed a post hoc analysis of the ARISTOTLE trial, which included >18,000 patients with AF randomized to warfarin (target international normalized ratio, 2.0-3.0) or apixaban 5 mg twice daily. Multivariable Cox regression analysis was used to determine if anemia (defined as hemoglobinResults Anemia was present at baseline in 12.6% of the ARISTOTLE population. Patients with anemia were older, had higher mean CHADS2 and HAS-BLED scores, and were more likely to have experienced previous bleeding events. Anemia was associated with major bleeding (adjusted hazard ratio [HR], 1.92; 95% CI, 1.62-2.28; P <.0001) and all-cause mortality (adjusted HR, 1.68; 95% CI, 1.46-1.93; PConclusions Chronic anemia is associated with a higher incidence of bleeding complications and mortality, but not of stroke, in anticoagulated patients with AF. Apixaban is an attractive anticoagulant for stroke prevention in patients with AF with or without anemia.

KW - RISK-PREDICTION SCORES

KW - NET CLINICAL BENEFIT

KW - ANTITHROMBOTIC THERAPY

KW - PREVENT STROKE

KW - WARFARIN

KW - ANTICOAGULATION

KW - METAANALYSIS

KW - PERFORMANCE

KW - MANAGEMENT

KW - HEMORR(2)HAGES

U2 - 10.1016/j.ahj.2016.12.008

DO - 10.1016/j.ahj.2016.12.008

M3 - Article

C2 - 28267467

SN - 0002-8703

VL - 185

SP - 140

EP - 149

JO - American Heart Journal

JF - American Heart Journal

ER -

Westenbrink BD, Alings M, Granger CB, Alexander JH, Lopes RD, Hylek EM et al. Anemia is associated with bleeding and mortality, but not stroke, in patients with atrial fibrillation: Insights from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial. American Heart Journal. 2017 Mar;185:140-149. doi: 10.1016/j.ahj.2016.12.008