Persistent Systemic Inflammation Is Associated With Bleeding Risk in Atrial Fibrillation Patients

Area of Science:

• Cardiology
• Internal Medicine
• Pharmacology

Background:

• Non-valvular atrial fibrillation (NVAF) patients on direct oral anticoagulants (DOACs) face bleeding risks.
• Systemic inflammation is a potential, under-explored factor influencing bleeding in these patients.

Purpose of the Study:

• To investigate the impact of systemic inflammation on major bleeding risk in NVAF patients treated with DOACs.
• To develop and validate a novel bleeding risk assessment score incorporating inflammatory markers.

Main Methods:

• Prospective registry (DIRECT) of 2,216 NVAF patients on DOACs.
• Measurement of high-sensitivity C-reactive protein (hsCRP) pre- and post-DOAC initiation.
• Multivariate logistic regression and survival analysis to assess bleeding risk factors.
• Development of the ORBIT-i score including post-DOAC hsCRP and ORBIT score components.

Main Results:

• Post-DOAC hsCRP levels significantly correlated with increased major bleeding risk (OR, 2.770; P<0.001).
• Patients with post-DOAC hsCRP >0.100 mg/dL experienced more frequent major bleeding events.
• The novel ORBIT-i score demonstrated superior discriminative performance (C-index 0.711) compared to ORBIT and HAS-BLED scores.

Conclusions:

• Persistent systemic inflammation, indicated by elevated post-DOAC hsCRP, is a significant predictor of major bleeding in NVAF patients.
• The ORBIT-i score offers improved accuracy in assessing bleeding risk compared to conventional scores.
• Inflammation assessment should be considered in managing bleeding risk for NVAF patients on DOAC therapy.