Aortic valve stenosis provides complementary information to bleeding risk scores in non-valvular atrial fibrillation patients initiating anticoagulation
Por:
Elvira-Ruiz, G, Caro-Martinez, C, Flores-Blanco, P, Cerezo-Manchado, J, Albendin-Iglesias, H, Lova-Navarro, A, Arregui-Montoya, F, Munoz-Franco, F, Garcia-Iniesta, N, Garcia-Alberola, A, Bailen-Lorenzo, J, Pascual-Figal, D and Manzano-Fernandez, S
Publicada:
1 ene 2020
Resumen:
Background The identification of modifiable bleeding risk factors may be of relevance. The aim is to evaluate if aortic stenosis (AS) provides additional information to bleeding risk scores for predicting major bleeding (MB) in non-valvular atrial fibrillation (AF). Methods We designed a retrospective multi-center study including 2880 consecutive non-valvular AF patients initiating oral anticoagulation between January 2013 and December 2016. AS was defined as moderate or severe according to European echocardiography guidelines criteria. HASBLED, ATRIA and ORBIT scores were used to evaluate the bleeding risk. MB was defined according to the International Society on Thrombosis and Haemostasia criteria and registered at 18 months of follow-up. Results 168 (5.8%) patients had AS. Patients with AS had higher risk for MB compared to those without AS (HR = 2.13, 95% CI: 1.40-3.23, P < 0.001). Patients without AS and low-intermediate bleeding risk (0 points) showed the lowest MB rate, whereas the MB rate observed among patients with AS and high bleeding risk (2 points) was the highest one. Discrimination and reclassification analyses showed that AS provided additional information to bleeding risk scores for predicting MB at 18 months of follow-up. Conclusions In this population, AS was associated with an increased risk for MB at midterm follow-up. The three scoring systems showed a moderate discriminatory ability for MB. Moreover, the addition of AS was associated with a significant improvement in their predictive accuracy. We suggest that the presence of this valvulopathy should be taken into account for bleeding risk assessment.
Filiaciones:
Elvira-Ruiz, G:
Univ Hosp Virgen Arrixaca, Dept Cardiol, Murcia, Spain
Inst Murciano Invest Biomed IMIB, Murcia, Spain
Caro-Martinez, C:
Univ Hosp Morales Meseguer, Dept Cardiol, Murcia, Spain
Univ Hosp Virgen Arrixaca, Dept Hematol, Murcia, Spain
Flores-Blanco, P:
Univ Hosp Virgen Arrixaca, Dept Cardiol, Murcia, Spain
Inst Murciano Invest Biomed IMIB, Murcia, Spain
Cerezo-Manchado, J:
Inst Murciano Invest Biomed IMIB, Murcia, Spain
Univ Hosp Virgen Arrixaca, Dept Hematol, Murcia, Spain
Albendin-Iglesias, H:
Inst Murciano Invest Biomed IMIB, Murcia, Spain
Univ Hosp Virgen Arrixaca, Dept Internal Med, Murcia, Spain
Lova-Navarro, A:
Univ Hosp Virgen Arrixaca, Dept Cardiol, Murcia, Spain
Inst Murciano Invest Biomed IMIB, Murcia, Spain
Arregui-Montoya, F:
Univ Hosp Virgen Arrixaca, Dept Cardiol, Murcia, Spain
Inst Murciano Invest Biomed IMIB, Murcia, Spain
Munoz-Franco, F:
Univ Hosp Virgen Arrixaca, Dept Cardiol, Murcia, Spain
Inst Murciano Invest Biomed IMIB, Murcia, Spain
Garcia-Iniesta, N:
Univ Hosp Virgen Arrixaca, Dept Cardiol, Murcia, Spain
Inst Murciano Invest Biomed IMIB, Murcia, Spain
Garcia-Alberola, A:
Univ Hosp Virgen Arrixaca, Dept Cardiol, Murcia, Spain
Inst Murciano Invest Biomed IMIB, Murcia, Spain
Univ Murcia, Sch Med, Murcia, Spain
:
Hosp Vega Baja, Dept Cardiol, Alicante, Spain
Pascual-Figal, D:
Univ Hosp Virgen Arrixaca, Dept Cardiol, Murcia, Spain
Inst Murciano Invest Biomed IMIB, Murcia, Spain
Univ Murcia, Sch Med, Murcia, Spain
Manzano-Fernandez, S:
Univ Hosp Virgen Arrixaca, Dept Cardiol, Murcia, Spain
Inst Murciano Invest Biomed IMIB, Murcia, Spain
Univ Murcia, Sch Med, Murcia, Spain
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