Clinical predictors of recurrent strokes and bleeding in patients with atrial fibrillation receiving oral anticoagulation (20-year follow-up in the register of long-term antithrombotic therapy [REGATA-2])

Kropacheva E.S.; Zemlyanskaya O.A.; Panchenko E.P.

doi:https://doi.org/10.17116/Cardiobulletin20241901164

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OBJECTIVE

To evaluate the incidence and structure of clinical and laboratory predictors of recurrent prognostic events (thromboembolism and bleeding) in AF patients receiving oral anticoagulation as part of a long-term prospective follow-up.

MATERIAL AND METHODS

This fragment included 125 AF patients from the REGATA-2 registry (Register of Long-term Antithrombotic Therapy (NCT043447187) who survived the first adverse event (stroke or bleeding) and continued anticoagulation (warfarin or one of the direct oral anticoagulants). During further follow-up (median 3.6 years), prognostic-determining negative events were recorded: ischemic stroke/transient ischemic attack and bleeding BARC type 2—5.

RESULTS

Incidence of repeated prognostic events (ischemic stroke/transient ischemic attack/bleeding BARC type 2—5) was 20.6/100 patient-years. Bleedings prevailed among all events, ischemic strokes — among fatal events. Incidence of fatal events was significantly higher among patients who continued warfarin compared to DOACs. Independent predictors (Cox proportional risks model) of relapse of any prognostic event were CCI score ≥7 (HR=2.0), age <65 years (HR=2.1), diabetes mellitus (HR=2.0) and chronic kidney disease ≥3a (HR=2.2).

CONCLUSION

Patients with any prognosis-defining event despite anticoagulation are at extremely high risk of recurrence. This necessitates an individual approach based on optimization of anticoagulation and maximum correction of all risk factors.

Keywords:

atrial fibrillation

anticoagulants

recurrent bleeding

recurrent stroke

Authors:

Kropacheva E.S.

Chazov National Medical Research Center of Cardiology

ORCID: 0000-0002-3092-8593

Zemlyanskaya O.A.

Chazov National Medical Research Center of Cardiology

ORCID: 0000-0003-4035-2943

Panchenko E.P.

Chazov National Medical Research Center of Cardiology

ORCID: 0000-0002-9158-2522

Received:

25.08.2023

Accepted:

11.09.2023

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References:

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