Anticoagulation Changes Following Major and Clinically Relevant Nonmajor Bleeding Events in Non-valvular Atrial...

Area of Science:

• Cardiology
• Pharmacology
• Hematology

Background:

• Bleeding events are frequent complications of oral anticoagulants like warfarin and direct oral anticoagulants (DOACs).
• Management strategies post-bleeding vary, with some patients discontinuing or changing anticoagulation, while others continue.
• Comparative management of warfarin versus DOACs after bleeding events remains unclear.

Purpose of the Study:

• To compare anticoagulation management strategies after bleeding events in patients treated with warfarin versus DOACs.
• To determine the rates of anticoagulant discontinuation, drug class change, or continuation following major or clinically relevant non-major bleeding.
• To identify factors influencing anticoagulation management post-bleeding.

Main Methods:

• Retrospective analysis of patients with non-valvular atrial fibrillation from six anticoagulation clinics (2016-2020).
• Inclusion of patients experiencing ISTH-defined major or CRNM bleeding events while on warfarin or DOAC therapy.
• Propensity matching of DOAC and warfarin groups based on CHA2DS2-VASc, HAS-BLED scores, and bleeding severity.

Main Results:

• A total of 509 warfarin patients and 246 DOAC patients experienced bleeding events.
• The majority of patients in both groups continued anticoagulation therapy post-bleeding.
• Most warfarin patients (62.6%) and DOAC patients (81.7%) restarted their previous anticoagulation drug class.

Conclusions:

• Anticoagulation therapy is frequently continued after bleeding events.
• Restarting the same anticoagulant drug class is the most common management strategy post-bleeding for both warfarin and DOAC users.
• These findings suggest a trend towards maintaining anticoagulation to prevent thrombotic events despite prior bleeding complications.