Bleeding in anticoagulated patients with atrial fibrillation: practical considerations

Abstract

or higher, but they are safer and more convenient. 7,8 In a meta-analysis of pivotal phase 3 AF randomized controlled trials (RCTs), NOACs reduced the risk of stroke or SE by 19% compared with warfarin (relative risk [RR], 0.81; 95% CI, 0.73-0.91), largely due to a markedly lower rate of hemorrhagic strokes (RR 0.49, 95% CI, 0.38-0.64) and intracranial bleeding (ICB) (RR, 0.48; 95% CI, 0.39-0.59). 9 However, the use of NOACs (in particular, full-dose dabigatran and rivaroxaban) was significantly associated with an increased risk of gastrointestinal (GI) bleeding (RR, 1.25; 95% CI, 1.01-1.55). 7 Of note, the differences between baseline stroke and bleeding risks among different NOAC trials could have affected the reported bleeding rates (FIGURE 1). Residual incidence of stroke or SE despite NOAC use among patients with AF is estimated at 1.5% to 2.5% per year and that of major bleeding at 2% to 4% per year. 9 As compared with warfarin, NOACs slightly reduced all-cause mortality (RR

Stroke Prevention with Anticoagulant in Cardiovascular Problem: Focus in Atrial Fibrillation

“…Consideration should also be given to the patient's age and susceptibility, body weight, renal function and other comorbidities that may influence the choice. Proton pump inhibitors (PPIs) may be considered to reduce the risk of gastrointestinal bleeding, especially in patients with a history of bleeding or gastrointestinal ulcers, and patients requiring co-medication of double antiplatelet therapy [106][107][108][109][110][111].…”