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Retrospective cohort study on long-term anticoagulation therapy for bleeding complications among atrial fibrillation

Megha Joy1, Bethamcherla Bala Chandrudu2, Mohamed Thoufeek Hussain Amjat Ibrahim3

  • 1Department of Internal Medicine, Queen Elizabeth Queen Mother Hospital, Margate, United Kingdom.

Bioinformation
|December 30, 2025
PubMed

Insights

Bleeding risks in atrial fibrillation patients on anticoagulants are linked to unstable international normalized ratio (INR) and medication type. Warfarin posed higher bleeding risks than direct oral anticoagulants (DOACs), highlighting the need for personalized treatment.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Atrial fibrillation (AF) necessitates long-term anticoagulation to prevent stroke.
  • Bleeding is a significant complication of anticoagulant therapy in AF patients.
  • Understanding bleeding risk factors is crucial for optimizing patient safety.

Purpose of the Study:

  • To determine the frequency and contributing factors of bleeding complications in AF patients on long-term oral anticoagulants.
  • To compare bleeding risks between warfarin and direct oral anticoagulants (DOACs).

Main Methods:

  • Retrospective analysis of medical records for 142 AF patients.
  • Assessment of bleeding episodes over a three-year period.
  • Evaluation of anticoagulant type (warfarin vs. DOACs) and international normalized ratio (INR) stability.

Main Results:

  • Bleeding complications were associated with unstable INR values.
  • Warfarin treatment was linked to a higher frequency of bleeding events compared to DOACs.
  • Patient-specific characteristics also contributed to bleeding risk.

Conclusions:

  • Unstable INR and warfarin use are significant risk factors for bleeding in AF patients.
  • DOACs may offer a safer alternative with lower bleeding rates.
  • Tailored anticoagulation strategies are essential for managing bleeding risks in AF.

Keywords:
DOACsINR fluctuationWarfarinanticoagulationatrial fibrillationbleeding risklong-term treatment

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