Oral anticoagulation among atrial fibrillation patients with anaemia: an observational cohort study

被引：38

作者：

Bonde, Anders Nissen ^{[1
,2
]}

Blanche, Paul ^{[1
,3
,4
]}

Staerk, Laila ^{[1
]}

Gerds, Thomas Alexander ^{[3
,5
]}

Gundlund, Anna ^{[1
]}

Gislason, Gunnar ^{[1
,5
]}

Torp-Pedersen, Christian ^{[1
,6
,7
,8
]}

Lip, Gregory Y. H. ^{[9
,10
,11
]}

Hlatky, Mark A. ^{[2
]}

Olesen, Jonas Bjerring ^{[1
]}

机构：

[1] Copenhagen Univ Hosp Herlev & Gentofte, Dept Cardiol, Post 635,Kildegaardsvej 28, DK-2900 Hellerup, Denmark

[2] Stanford Univ, Dept Hlth Res & Policy, Sch Med, Campus Dr, Stanford, CA 94305 USA

[3] Univ Copenhagen, Sect Biostat, Dept Publ Hlth, DK-1014 Copenhagen K, Denmark

[4] Univ Copenhagen, Rigshosp, Heart Ctr, Dept Cardiol, 2100 Blegdamsvej, Copenhagen, Denmark

[5] Danish Heart Fdn, Dept Cardiovasc Epidemiol & Res, DK-1120 Copenhagen, Denmark

[6] Aalborg Univ, Dept Hlth Sci & Technol, 9220 Frederik Bajers Vej, Aalborg, Denmark

[7] Aalborg Univ Hosp, Dept Cardiol, 9000 Hobrovej, Aalborg, Denmark

[8] Aalborg Univ Hosp, Dept Epidemiol Biostat, 9000 Hobrovej, Aalborg, Denmark

[9] Univ Liverpool, Liverpool Ctr Cardiovasc Sci, Liverpool L69 3BX, Merseyside, England

[10] Liverpool Heart & Chest Hosp, Liverpool L69 3BX, Merseyside, England

[11] Aalborg Univ, Dept Clin Med, Aalborg Thrombosis Res Unit, Sondre Skovvej, DK-9100 Aalborg, Denmark

来源：

EUROPEAN HEART JOURNAL | 2019年 / 40卷 / 46期

关键词：

Atrial fibrillation; Anticoagulation; Anaemia; CHRONIC KIDNEY-DISEASE; ANTITHROMBOTIC THERAPY; THROMBOEMBOLIC EVENTS; STROKE; MORTALITY; COLLABORATION; METAANALYSIS; GUIDELINES; INSIGHTS; WARFARIN;

D O I：

10.1093/eurheartj/ehz155

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Aims To investigate the risk of stroke/thromboembolism (TE) and major bleeding associated with anaemia among patients with atrial fibrillation (AF). Also, to assess the effects of oral anticoagulation (OAC) and time in therapeutic range (TTR) with vitamin K antagonists according to level of haemoglobin (Hb). Methods and results Through administrative registry databases, we identified all Danish patients diagnosed with AF from 1997 to 2012. We included 18 734 AF patients with recent available data on Hb. Multiple Cox regression analyses were used to estimate hazard ratios and to compute standardized absolute 1-year risks of stroke/TE and major bleeding. Among included patients, 3796 (20%) had mild anaemia (Hb 6.83-7.45 mmol/L for women and Hb 6.83-8.03 mmol/L for men) and 2562 (14%) had moderate/severe anaemia (Hb <6.83mmol/L). Moderate/severe anaemia was associated with increased risk of major bleeding and 9.1% lower median TTR compared with no anaemia. Use of OAC was associated with reduced risk of stroke/TE among patients without anaemia [standardized absolute 1-year difference -2.5%, 95% confidence interval (CI) -3.8 to -1.7%] or with mild anaemia (-2.3%, 95% CI -2.8 to -1.8%), but not with moderate/severe anaemia, (0.03%, -1.8 to +2.8%, interaction P = 0.01). Oral anticoagulation was associated with a 5.3% (95% CI 2.1-8.7%) increased standardized absolute risk of major bleeding among AF patients with moderate/severe anaemia. Conclusion Anaemia was common in patients with AF and associated with major bleeding and lower TTR. Oral anticoagulation was associated with more major bleeding, but no reduction in risk of stroke/TE among AF patients with moderate/severe anaemia.

引用

页码：3782 / 3790

页数：9

共 30 条

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