Atrial fibrillation patients use same anticoagulant after bleeding event

A recent study has shown that the majority of patients with nonvalvular atrial fibrillation who have had a bleeding event resume anticoagulation therapy usually with the same drug class that they have been using.

“Following a bleeding event, most patients restarted anticoagulation therapy, most often with the same type of anticoagulant that they previously had been taking,” the investigators said.

In total, 509 patients on warfarin therapy and 246 on direct oral anticoagulants (DOACs) experienced a major or clinically relevant nonmajor bleeding event. Most of these patients continued anticoagulation therapy, with 231 (62.6 percent) of those on warfarin and 201 (81.7 percent) on DOAC restarting their previous anticoagulant.

The investigators of this study identified patients with nonvalvular atrial fibrillation from six anticoagulation clinics taking warfarin or DOAC therapy who experienced an International Society of Thrombosis and Haemostasis (ISTH)-defined major or clinically relevant nonmajor bleeding event between 2016 and 2020.

DOAC- and warfarin-treated patients were propensity matched based on the individual elements of the CHA2DS2-VASc and HAS-BLED scores, as well as the severity of the bleeding event. Management of the anticoagulant following bleeding (ie, discontinuation, change in drug class, and restarting of same drug class) was the primary outcome of the study.

“Bleeding events are common complications of oral anticoagulant drugs, including both warfarin and DOACs,” the investigators said. “Some patients have their anticoagulant changed or discontinued after experiencing a bleeding event, while others continue the same treatment.”