Stroke and Bleeding Risk Co-distribution in Real-world Patients with Atrial Fibrillation: The Euro Heart Survey - 12/10/14
, Gregory Y.H. Lip, MD c, Robby Nieuwlaat, PhD a, d, Ron Pisters, PhD e, Harry J.G.M. Crijns, MD e, Alfonso Iorio, MD aAbstract |
Background |
The choice to recommend antithrombotic therapy to patients with atrial fibrillation should rely on cardioembolic and bleeding risk stratification. Sharing some risk factors, schemes to predict thrombotic and bleeding risk are expected not to be independent, yet the degree of their association has never been clearly quantified.
Methods |
We described the cardioembolic (Congestive heart failure, Hypertension, Age >75, Diabetes mellitus, and prior Stroke or transient ischemic attack [CHADS2]/Congestive heart failure, Hypertension, Age >75, Diabetes mellitus, and prior Stroke or transient ischemic attack, Vascular disease, Age 65-75, Sex category i.e. females [CHA2DS2-VASc]) and bleeding risk (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly (>65 years), Drugs/alcohol concomitantly [HAS-BLED]) co-distribution among patients of the Euro Heart Survey on atrial fibrillation. We measured the within-patient correlation (Spearman) and concordance between the 2 types of score and score-based risk categorization (low, intermediate, high). The score-based predicted risk co-classification was then related to the observed 1-year stroke and bleeding occurrence.
Results |
In 3920 patients, we found a between-scores correlation of 0.416 (P < .001) between HAS-BLED and CHADS2, and 0.512 (P < .001) between HAS-BLED and CHA2DS2-VASc. In 89% (CHADS2/HAS-BLED) and 97% (CHA2DS2-VASc/HAS-BLED) of patients, the bleeding risk category was equal to or lower than their cardioembolic risk category (P < .001 for symmetry test). A complete concordance between risk categories was found in 39.6% (CHADS2/HAS-BLED) and 21.7% (CHA2DS2-VASc/HAS-BLED) of patients; 4.4% (CHADS2/HAS-BLED) and 7.7% (CHA2DS2-VASc/HAS-BLED) of patients had high cardioembolic risk/low bleeding risk or vice versa. A tendency for an increasing frequency of stroke was observed for increasing bleeding risk within cardioembolic risk categories and vice versa.
Conclusions |
In a real-world population with atrial fibrillation, we confirmed that the cardioembolic and bleeding risk classifications are correlated but not exchangeable. It is then worth verifying the advantages of a strategy adopting a combined risk assessment over a strategy relying only on the cardioembolic risk evaluation.
El texto completo de este artículo está disponible en PDF.Keywords : Atrial fibrillation, Cardioembolic and bleeding risk co-stratification
Esquema
| Funding: The Euro Heart Survey is funded by industry sponsors AstraZeneca, Sanofi-Aventis, and Eucomed, and by the Austrian Heart Foundation, Austrian Society of Cardiology, Fédération Française de Cardiologie, Hellenic Cardiological Society, Netherlands Heart Foundation, Portuguese Society of Cardiology, Spanish Cardiac Society, Swedish Heart and Lung Foundation, and individual centers. |
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| Conflict of Interest: Dr Lip has served as a consultant for Bayer, Astellas, Merck, AstraZeneca, Sanofi-Aventis, Aryx, Portola, Biotronic, and Boehringer Ingelheim, and has been on the speakers bureau for Bayer, Boehringer Ingelheim, and Sanofi-Aventis. Dr Pisters has received consulting fees from Bayer and Boehringer Ingelheim and lecture fees from Boehringer Ingelheim. Dr Crijns has received grant support from St Jude Medical, Medtronic, Boehringer Ingelheim, Bayer, Bristol-Myers Squibb, and Pfizer. Dr Iorio has received honoraria as speaker, consultant, and advisory board member for Bayer, Baxter, Biogen Idec, Novo Nordisk, and Pfizer. Drs Marcucci and Nieuwlaat have reported no potential conflicts of interest. |
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| Authorship: All authors had access to the data and played a role in writing this manuscript. |
Vol 127 - N° 10
P. 979 - octobre 2014 Regresar al número
Artículo precedente
- Prior History of Falls and Risk of Outcomes in Atrial Fibrillation: The Loire Valley Atrial Fibrillation Project
- Amitava Banerjee, Nicolas Clementy, Ken Haguenoer, Laurent Fauchier, Gregory Y.H. Lip
- Statins and Contrast-induced Acute Kidney Injury with Coronary Angiography
- Sumeet Gandhi, Wassim Mosleh, Husam Abdel-Qadir, Michael E. Farkouh
Bienvenido a EM-consulte, la referencia de los profesionales de la salud.
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