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Published on: February 26, 2013
Thrombocytopenia as a Bleeding Risk Factor in Atrial Fibrillation and Coronary Artery Disease: Insights From the
Raisuke Iijima1, Masahide Tokue2, Masato Nakamura1
1Division of Cardiovascular Medicine Toho University Ohashi Medical Center Tokyo Japan.
Insights
Thrombocytopenia significantly increases major bleeding risk in atrial fibrillation and chronic coronary syndrome patients. Careful drug selection is crucial for these patients on antithrombotic therapy.
Area of Science:
- Cardiology
- Hematology
- Clinical Trials
Background:
- Thrombocytopenia (low platelet count) is a known bleeding risk factor in chronic coronary syndrome patients post-intervention.
- The specific bleeding risk associated with thrombocytopenia in patients with both atrial fibrillation and chronic coronary syndrome is not well-established.
Purpose of the Study:
- To investigate the association between thrombocytopenia and the risk of major bleeding and adverse cardiovascular events.
- To evaluate the impact of thrombocytopenia on bleeding risk in patients with atrial fibrillation and chronic coronary syndrome receiving antithrombotic therapy.
Main Methods:
- Analysis of the AFIRE trial data, including 2133 patients.
- Classification of patients into thrombocytopenia (<100,000/mm³ platelets) and non-thrombocytopenia groups.
- Assessment of primary endpoints: major bleeding (ISTH criteria) and major adverse cardiovascular ischemic events (MACICE).
Main Results:
- Major bleeding occurred significantly more often in the thrombocytopenia group (10.0% vs. 4.1%, P=0.027).
- The thrombocytopenia group showed a trend towards higher MACICE risk (11.4% vs. 6.2%, P=0.08).
- Bleeding risk was markedly higher in thrombocytopenic patients on combination therapy (rivaroxaban + single antiplatelet): 14.3% vs. 5.0% (HR, 3.18; P=0.014).
- Thrombocytopenia independently predicted major bleeding (HR, 2.57; P=0.017).
Conclusions:
- Thrombocytopenia is a significant independent predictor of major bleeding in patients with atrial fibrillation and chronic coronary syndrome.
- These findings highlight the need for careful consideration when selecting antithrombotic therapies for thrombocytopenic patients.
- Further research may be warranted to optimize treatment strategies for this high-risk population.
Abstract:
Background Thrombocytopenia poses a risk of bleeding in patients with chronic coronary syndrome after coronary intervention. However, whether thrombocytopenia also increases the bleeding risk in patients with atrial fibrillation and chronic coronary syndrome remains unclear. Methods and Results This study evaluated the AFIRE (Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease) trial. Thrombocytopenia was defined as platelet count <100 000/mm3 level at enrollment. Primary end points included incidence of major bleeding based on the International Society on Thrombosis and Hemostasis criterion and major adverse cardiovascular ischemic events (cardiac death, myocardial infarction, and stroke). A total of 2133 patients were classified into the thrombocytopenia (n=70) and nonthrombocytopenia (n=2063) groups. Major bleeding was significantly higher in the thrombocytopenia group than in the nonthrombocytopenia group (10.0% versus 4.1%, P=0.027). The thrombocytopenia group tended to have a higher risk of major adverse cardiovascular ischemic events (11.4% versus 6.2%, P=0.08). The bleeding incidence was significantly higher in patients with thrombocytopenia receiving combination therapy with rivaroxaban and a single antiplatelet drug (thrombocytopenia group, 14.3%, versus nonthrombocytopenia group, 5.0%; hazard ratio, 3.18 [95% CI, 1.27-7.97], P=0.014). Thrombocytopenia was an independent predictor of major bleeding (hazard ratio, 2.57 [95% CI, 1.19-5.56], P=0.017). Conclusions Among patients with atrial fibrillation and chronic coronary syndrome, thrombocytopenia was significantly associated with increased risk of major bleeding. Selecting drugs for patients with thrombocytopenia continuing antithrombotic therapy should be given special consideration. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02642419. https://www.umin.ac.jp/ctr/; Unique identifier: UMIN000016612.
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