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Restarting of anticoagulation in patients with atrial fibrillation after major bleeding: A meta-analysis

Ying Zhou1, Yujie Guo1, Daihua Liu2

  • 1Department of Healthcare Medicine, Liuzhou People's Hospital, Liuzhou, China.

Journal of Clinical Pharmacy and Therapeutics
|March 18, 2020
PubMed

Insights

Restarting oral anticoagulants (OACs) in atrial fibrillation (AF) patients after major bleeding significantly reduces thromboembolism and mortality risks. This practice does not increase the risk of recurrent bleeding events, offering a safer therapeutic option.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Research

Background:

  • The safety and efficacy of restarting oral anticoagulants (OACs) after major bleeding in patients with atrial fibrillation (AF) are not well-established.
  • Existing data are limited, necessitating a comprehensive evaluation of the benefits and risks.

Purpose of the Study:

  • To systematically evaluate the impact of restarting OACs on thromboembolic events and recurrent bleeding in AF patients post-major bleeding.
  • To compare the effects of different types of OACs and analyze bleeding recurrence at various sites.

Main Methods:

  • A meta-analysis of seven retrospective cohort studies involving 12,197 patients.
  • Systematic literature search across PubMed, Cochrane's Library, and Embase databases.
  • Random-effect model for result pooling, with subgroup analyses for OAC types and bleeding sites.

Main Results:

  • Restarting OACs was linked to a reduced risk of thromboembolism (RR: 0.61, P=0.007) and all-cause mortality (RR: 0.42, P<0.001).
  • Warfarin showed a trend towards reduced thromboembolism risk, while NOACs did not reach statistical significance.
  • No significant increase in recurrent bleeding events was observed (RR: 0.98, P=0.89) for OACs, warfarin, or NOACs.

Conclusions:

  • Restarting OACs in AF patients after major bleeding is associated with decreased risks of thromboembolism and mortality.
  • This strategy appears safe regarding recurrent bleeding, supporting its consideration in clinical practice.
  • Further research may clarify differential effects between warfarin and NOACs.
Abstract

Keywords:
atrial fibrillationmajor bleedingmeta-analysisoral anticoagulantsrestart

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