Related Experiment Video
Updated: Jan 1, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Ischemic and Bleeding Outcomes in Patients With Atrial Fibrillation and Contraindications to Oral Anticoagulation
Benjamin A Steinberg1, Nicholas G Ballew2, Melissa A Greiner2
1Division of Cardiovascular Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah.
Insights
Patients with atrial fibrillation (AF) and high bleeding risk contraindications to oral anticoagulation (OAC) face worse outcomes. OAC use in this group reduces mortality and stroke but increases intracranial hemorrhage risk.
Area of Science:
- Cardiology
- Clinical Outcomes Research
- Pharmacology
Background:
- Oral anticoagulation (OAC) is crucial for preventing stroke and death in atrial fibrillation (AF) patients.
- However, a significant portion of AF patients have contraindications to OAC, primarily due to high bleeding risk.
- Common contraindications include blood dyscrasia and a history of gastrointestinal bleeding.
Purpose of the Study:
- To investigate clinical outcomes in atrial fibrillation (AF) patients with contraindications to oral anticoagulation (OAC).
- To compare outcomes between AF patients with and without OAC contraindications.
- To evaluate the impact of OAC use on clinical outcomes in patients with contraindications.
Main Methods:
- Observational, longitudinal analysis of a 5% Medicare sample of chronic AF patients with CHA 2 DS 2 -VASc score ≥2.
- Stratification based on high bleeding risk contraindications to OAC and OAC use.
- Assessment of 3-year ischemic and bleeding outcomes using multivariable Cox proportional hazards models.
Main Results:
- 31% of 26,684 AF patients not on OAC had high bleeding risk contraindications.
- Patients with contraindications had worse ischemic and bleeding outcomes compared to those without.
- OAC use in patients with contraindications was linked to reduced mortality, stroke, and hospitalization, but a higher risk of intracranial hemorrhage.
Conclusions:
- High bleeding risk contraindications are prevalent in older AF patients, correlating with increased mortality.
- OAC use in AF patients with contraindications offers benefits in reducing stroke, hospitalization, and death.
- Careful consideration of the increased intracranial hemorrhage risk is necessary when prescribing OAC to these patients.
Objectives:
This study sought to describe clinical outcomes among patients with atrial fibrillation (AF) and contraindications to oral anticoagulation (OAC).
Background:
Treatment with OAC prevents stroke and death in patients with AF, but may be contraindicated among patients at high bleeding risk.
Methods:
This was an observational, longitudinal analysis of a nationally representative 5% Medicare sample of patients with chronic AF and CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism, vascular disease, age 65-74 years, sex category) score ≥2. They were stratified by both the presence of high bleeding risk contraindications to OAC and by OAC use. We assessed 3-year ischemic and bleeding outcomes using multivariable Cox proportional hazards models adjusted for relevant patient characteristics.
Results:
Among 26,684 AF patients not treated with OAC, 8,283 (31%) had a high bleeding risk contraindication, primarily a blood dyscrasia (75%) or history of gastrointestinal bleeding (40%). Without OAC, patients with contraindications had worse ischemic and bleeding outcomes at 3 years compared with those without contraindications. We also identified 12,454 patients with OAC contraindications who received OAC. Compared with patients not receiving OAC, use of OAC was associated with reduced mortality (adjusted hazard ratio [HR]: 0.79; 95% confidence interval [CI]: 0.76 to 0.83), stroke (adjusted HR: 0.90; 95% CI: 0.83 to 0.99), and all-cause hospitalization (adjusted HR: 0.93; 95% CI: 0.90 to 0.96) but increased risk of intracranial hemorrhage (adjusted HR: 1.42; 95% CI: 1.17 to 1.72).
Conclusions:
High bleeding risk contraindications to OAC are common among older patients with AF, and these patients have higher mortality compared with untreated patients without OAC contraindications. The use of OAC in these patients is associated with lower rates of all-cause stroke, hospitalization, and death but higher risk of intracranial hemorrhage.
Related Concept Videos
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
01:29Venous Thrombosis III: Interprofessional Care
01:24Disorders of Hemostasis
Thromboembolic Disorders
Two factors primarily cause thromboembolic conditions.
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:30Venous Thrombosis IV: Nursing Management