TY - JOUR
T1 - Anemia is associated with bleeding and mortality, but not stroke, in patients with atrial fibrillation
T2 - Insights from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial
AU - Westenbrink, B Daan
AU - Alings, Marco
AU - Granger, Christopher B
AU - Alexander, John H
AU - Lopes, Renato D
AU - Hylek, Elaine M
AU - Thomas, Laine
AU - Wojdyla, Daniel M
AU - Hanna, Michael
AU - Keltai, Matyas
AU - Steg, P Gabriel
AU - De Caterina, Raffaele
AU - Wallentin, Lars
AU - van Gilst, Wiek H
N1 - Publisher Copyright:
© 2016 The Authors
PY - 2017/3/1
Y1 - 2017/3/1
N2 - Background Patients with atrial fibrillation (AF) are prone to cardiovascular events and anticoagulation-related bleeding complications. We hypothesized that patients with anemia are at increased risk for these outcomes. Methods We performed a post hoc analysis of the ARISTOTLE trial, which included >18,000 patients with AF randomized to warfarin (target international normalized ratio, 2.0-3.0) or apixaban 5 mg twice daily. Multivariable Cox regression analysis was used to determine if anemia (defined as hemoglobin <13.0 in men and <12.0 g/dL in women) was associated with future stroke, major bleeding, or mortality. Results Anemia was present at baseline in 12.6% of the ARISTOTLE population. Patients with anemia were older, had higher mean CHADS
2 and HAS-BLED scores, and were more likely to have experienced previous bleeding events. Anemia was associated with major bleeding (adjusted hazard ratio [HR], 1.92; 95% CI, 1.62-2.28; P <.0001) and all-cause mortality (adjusted HR, 1.68; 95% CI, 1.46-1.93; P <.0001) but not stroke or systemic embolism (adjusted HR, 0.92; 95% CI, 0.70-1.21). The benefits of apixaban compared with warfarin on the rates of stroke, mortality, and bleeding events were consistent in patients with and without anemia. Conclusions Chronic anemia is associated with a higher incidence of bleeding complications and mortality, but not of stroke, in anticoagulated patients with AF. Apixaban is an attractive anticoagulant for stroke prevention in patients with AF with or without anemia.
AB - Background Patients with atrial fibrillation (AF) are prone to cardiovascular events and anticoagulation-related bleeding complications. We hypothesized that patients with anemia are at increased risk for these outcomes. Methods We performed a post hoc analysis of the ARISTOTLE trial, which included >18,000 patients with AF randomized to warfarin (target international normalized ratio, 2.0-3.0) or apixaban 5 mg twice daily. Multivariable Cox regression analysis was used to determine if anemia (defined as hemoglobin <13.0 in men and <12.0 g/dL in women) was associated with future stroke, major bleeding, or mortality. Results Anemia was present at baseline in 12.6% of the ARISTOTLE population. Patients with anemia were older, had higher mean CHADS
2 and HAS-BLED scores, and were more likely to have experienced previous bleeding events. Anemia was associated with major bleeding (adjusted hazard ratio [HR], 1.92; 95% CI, 1.62-2.28; P <.0001) and all-cause mortality (adjusted HR, 1.68; 95% CI, 1.46-1.93; P <.0001) but not stroke or systemic embolism (adjusted HR, 0.92; 95% CI, 0.70-1.21). The benefits of apixaban compared with warfarin on the rates of stroke, mortality, and bleeding events were consistent in patients with and without anemia. Conclusions Chronic anemia is associated with a higher incidence of bleeding complications and mortality, but not of stroke, in anticoagulated patients with AF. Apixaban is an attractive anticoagulant for stroke prevention in patients with AF with or without anemia.
KW - Aged
KW - Aged, 80 and over
KW - Anemia/epidemiology
KW - Anticoagulants/therapeutic use
KW - Atrial Fibrillation/complications
KW - Embolism/epidemiology
KW - Factor Xa Inhibitors/therapeutic use
KW - Female
KW - Hemorrhage/chemically induced
KW - Humans
KW - Incidence
KW - Male
KW - Middle Aged
KW - Mortality
KW - Multivariate Analysis
KW - Proportional Hazards Models
KW - Pyrazoles/therapeutic use
KW - Pyridones/therapeutic use
KW - Randomized Controlled Trials as Topic
KW - Stroke/epidemiology
KW - Thromboembolism/epidemiology
KW - Warfarin/therapeutic use
UR - http://www.scopus.com/inward/record.url?scp=85009273153&partnerID=8YFLogxK
U2 - 10.1016/j.ahj.2016.12.008
DO - 10.1016/j.ahj.2016.12.008
M3 - Article
C2 - 28267467
SN - 0002-8703
VL - 185
SP - 140
EP - 149
JO - American Heart Journal
JF - American Heart Journal
ER -