Author + information
- Iani Patsias,
- Chetan Mittal,
- Mohammad Elbatta,
- Kiran Garikapati,
- Patrick Bradley,
- Gagandeep Cheema,
- Aishwarya Kuchipudi,
- Hassaan Raza Jafri,
- Zaid Alirhayim,
- Syed Hassan,
- Fatima Khalid and
- Waqas Qureshi
Gastrointestinal bleeding (GIB) in anticoagulated atrial fibrillation (AF) patients occurs in 5-15% of the patients. Current guidelines recommend discontinuing and subsequently restarting anticoagulation (AC) after a month. We aimed to analyze the outcomes of restarting warfarin within 15-30 days of index GIB.
Retrospective consecutive data from the insurance prescription claims of warfarin from Jan 2005 – Dec 2010 of southeastern Michigan for patients with AF as primary indication for AC was obtained. Patients were divided into 4 subgroups based on their HASBLED and CHADS2 scores. GIB was defined as visible bleeding, occult bleeding, and endoscopic evidence of bleeding. Cox proportional hazard modelling for time to death, GIB and stroke was performed to calculate risk for various subgroups.
Out of 11584 patients with AC for non valvular AF, 1229 patients (mean age 75.6 ± 10.9, women 45.1%) developed GIB. Warfarin was restarted in 665 (46.8%) of the patients within 15-30 days of index GIB. There were 51 (7.6%) episodes of rebleeding within 3 months of restarting warfarin, 47 (7.1%) stroke/TIA and 224 (34.8%) deaths within one year. The risk of stroke was reduced in all the subgroups but risk of GIB and death was significantly high in groups with high HASBLED score (score >3) (table).
In conclusion, restarting warfarin earlier in AF patients with GIB after 15 days is safe and does not increase rebleeding in 3 months after index GIB.
Moderated Poster Contributions
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Atrial Fibrillation Mechanisms and Stroke Prevention
Abstract Category: 4. Arrhythmias: AF/SVT
Presentation Number: 1191M-50
- 2013 American College of Cardiology Foundation