Gastrointestinal Bleeding Risk Associated With Pulse Pressure in Patients With Atrial Fibrillation: Retrospective...

Area of Science:

• Cardiology
• Vascular Medicine
• Clinical Risk Stratification

Background:

• Patients with atrial fibrillation (AF) have high bleeding risks, especially with oral anticoagulation.
• Existing risk scores (e.g., HAS-BLED, ORBIT) have limited accuracy in predicting bleeding.
• Pulse pressure (PP), a marker of arterial stiffness, has not been evaluated for bleeding prediction in AF patients.

Purpose of the Study:

• To evaluate if elevated pulse pressure (PP) independently predicts major bleeding events in patients with AF.
• To assess PP's predictive accuracy for overall bleeding and specific subtypes (gastrointestinal, intracranial).
• To determine if PP improves risk stratification beyond established clinical factors.

Main Methods:

• Retrospective cohort study of 4935 AF patients using electronic health records (2010-2019).
• PP derived from outpatient blood pressure measurements, analyzed continuously and by tertiles.
• Primary outcome: time to first major bleeding event (composite of GI, intracranial, other).
• Multivariable Cox regression adjusted for clinical factors and ORBIT score; sensitivity analysis included SBP.

Main Results:

• Over 5 years, 13.7% of patients experienced a bleeding event.
• Elevated PP tertiles were associated with significantly higher gastrointestinal (GI) bleeding risk (P=.007).
• Each 1 mm Hg increase in PP independently predicted a 1.4% higher GI bleeding risk (HR 1.014, P=.04), even after adjusting for SBP and ORBIT score.

Conclusions:

• Pulse pressure (PP) is an independent predictor of GI bleeding in AF patients.
• PP offers enhanced bleeding risk prediction beyond current clinical risk factors and scores.
• PP is a readily available, low-cost parameter that can refine bleeding risk management in AF.