Sustained atrial fibrillation increases the risk of anticoagulation-related bleeding in heart failure

Prochaska, Jürgen H.; Göbel, Sebastian; Nagler, Markus; Knöpfler, Torben; Eggebrecht, Lisa; Lamparter, Heidrun; Panova‐Noeva, Marina; Keller, Karsten; Coldewey, Meike; Bickel, Christoph; Lauterbach, Michael; Hardt, Roland; Espinola‐Klein, Christine; Cate, Hugo Ten; Rostock, Thomas; Münzel, Thomas; Wild, Philipp S.

doi:10.1007/s00392-018-1293-4

Cited by 7 publications

(2 citation statements)

References 39 publications

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“…Finally, we cannot exclude the possibility of unmeasured confounders, such as type of AF. There has been a recent report of an independent association between sustained AF and an increased risk of bleeding in patients with HF [ 46 ]. In view of the small number of patients in our study who used antiarrhythmic agents, most patients likely had persistent AF, which could have contributed to the risk of bleeding.…”

Section: Discussionmentioning

confidence: 99%

Relation between laxative use and risk of major bleeding in patients with atrial fibrillation and heart failure

Yamamoto

Hara

et al. 2023

Heart Vessels

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Constipation has been reported to increase the risk of cardiovascular mortality. Patients with atrial fibrillation (AF) and heart failure (HF) have more comorbidities and an increased bleeding risk. However, it remains unclear whether constipation is associated with an increased risk of incident bleeding complications in AF with HF. Here, we investigated the association between constipation requiring laxatives and major bleeding in AF and HF. We retrospectively analyzed the medical records of 370 consecutive patients hospitalized for AF and congestive HF. Constipation was defined as regularly taking laxatives or having at least two prescriptions for a ≥ 30-day supply of laxatives. Sixty patients experienced major bleeding events during a median follow-up of 318 days. The most common sites of bleeding were lower gastrointestinal (28%, 17/60), upper gastrointestinal (27%, 16/60), and intracranial (20%, 12/60). There were 33 (55%) patients with constipation in the bleeding group and 107 (35%) in the non-bleeding group (P = 0.004). Multivariate Cox regression analysis adjusted for HAS-BLED score, hemoglobin, and direct oral anticoagulant use showed that constipation (hazard ratio [HR] 1.85, 95% confidence interval [CI] 1.11–3.08; p = 0.019) was a significant risk factor for major bleeding. We found a significant association between constipation requiring laxatives and major bleeding in patients with AF and HF. These findings indicate the need for constipation prevention in these patients to avoid reliance on invasive defecation management, including laxatives.

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Section: Discussionmentioning

confidence: 99%

Relation between laxative use and risk of major bleeding in patients with atrial fibrillation and heart failure

Yamamoto

Hara

et al. 2023

Heart Vessels

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“…The stroke risks were intensified when complicated with HF, as well as with comorbidities predisposing both AF and HF, such as hypertension and diabetes [8]. However, HF patients tended to have lower adherence to oral anticoagulation and might be more vulnerable to bleeding events when AF was sustained [9,29]. Furthermore, LAA thrombus was prevalent ranging between 40% and 68% in HF patients with sinus rhythm [12].…”

Section: The Combined Procedures On Stroke Preventionmentioning

confidence: 99%

Combined Radiofrequency Ablation and Left Atrial Appendage Closure in Atrial Fibrillation and Systolic Heart Failure

Sun,

Zhang,

Yang

et al. 2023

Diagnostics

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Background: Managing patients with atrial fibrillation (AF) and comorbid heart failure (HF) with reduced (HFrEF) or mildly reduced ejection fraction (HFmrEF) is of clinical importance but a great challenge. This study aimed to evaluate the clinical benefit of the combined radiofrequency catheter ablation (RFCA) and left atrial appendage closure (LAAC) procedure in AF patients complicated with systolic HF. Methods: AF patients with HFrEF or HFmrEF who underwent the combined RFCA and LAAC procedure were prospectively enrolled in the LAACablation registry. The procedural complications and long-term outcomes were evaluated. Another cohort of AF patients with systolic HF who did not undergo either RFCA or LAAC were used for prognosis comparison. Results: Among 802 AF patients who underwent the combined procedure, 65 patients were comorbid with systolic HF (25 with HFrEF and 40 with HFmrEF). The overall procedural complication rate was 9.2%, which was mainly attributed to acute decompensated HF (6.2%). Accompanied with markedly reduced AF burden (from median [25th, 75th percentile]: 100 [100, 100] to 0 [0, 1.2]%, p < 0.001), upward trajectories of cardiac function were observed in 51 (78.4%) patients, showing improvement in New York Heart Classification (p < 0.01), natriuretic peptide levels (from 1492 [809, 3259] to 413 [163, 880] pg/mL, p < 0.001) and left ventricular EF (from 42.6 ± 5.3 to 53.8 ± 8.2%, p < 0.001). During the 27-month follow-up period, death, thromboembolism, major bleeding, and HF rehospitalization were observed in three, one, one, and four patients, respectively. The observed event rates showed a significant reduction compared with the non-procedure AF-HF cohort (n = 138; for composite endpoint: hazard ratio: 2.509, 95% confidence interval: 1.415–4.449, p = 0.002) and with the respective rates predicted by risk scores. Conclusions: Combining RFCA and LAAC achieves acceptable safety and credible long-term efficacy in AF patients with systolic HF. Further randomized studies are warranted in a larger patient cohort.

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Aktuelles zur evidenzbasierten medikamentösen Herzinsuffizienztherapie

Emrich

Wintrich

Kindermann

et al. 2019

Herz

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Sustained atrial fibrillation increases the risk of anticoagulation-related bleeding in heart failure

Abstract: https://clinicaltrials.gov , identifier: NCT01809015.

Cited by 7 publications

References 39 publications

Relation between laxative use and risk of major bleeding in patients with atrial fibrillation and heart failure

Relation between laxative use and risk of major bleeding in patients with atrial fibrillation and heart failure

Combined Radiofrequency Ablation and Left Atrial Appendage Closure in Atrial Fibrillation and Systolic Heart Failure

Aktuelles zur evidenzbasierten medikamentösen Herzinsuffizienztherapie

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