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

Research output: Contribution to journalArticleAcademicpeer-review

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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 languageEnglish
Pages (from-to)140-149
Number of pages10
JournalAmerican Heart Journal
Volume185
DOIs
Publication statusPublished - 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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