Restarting oral anticoagulant therapy after major bleeding in atrial fibrillation: A systematic review and meta-analysis

Abstract

Restarting OAC therapy after a major bleeding event in AF was associated with a positive clinical benefit when compared to non-restarting OAC, with a significant reduction in any thromboembolism and all-cause mortality.

Predicting Bleeding Events in Anticoagulated Patients With Atrial Fibrillation: A Comparison Between the HAS‐BLED and GARFIELD‐AF Bleeding Scores

“…Also, all bleeding events are associated with an impaired quality of life 28. Irrespective of type, patients experiencing a bleeding event are more likely to discontinue OAC treatment,29 which is associated with an increased risk for clinically significant events 30…”

<p>When to withhold oral anticoagulation in atrial fibrillation – an overview of frequent clinical discussion topics</p>

“…Restarting OAC was associated with an increased risk of a recurrent major bleeding (OR 1.85), although no increased risk of recurrence of the index bleeding event (ie, ICH or GI-bleeding) was observed. NCB analysis, including thromboembolic events, major bleeding, and all-cause mortality, demonstrated that restarting OAC was associated with a clinical advantage (NCB 0.11 [95% CI 0.09–0.14]) 55. An important limitation, however, is that all included studies were observational, and selection bias in these studies is possible 56.…”

“…Recently, a meta-analysis was published comprising 5685 AF patients that experienced a major bleeding 55. In comparison with the withholding of OAC after the index bleeding, OAC restarters had a 46% relative risk (RR) reduction of any thromboembolic event, and a 10.8% absolute risk reduction for all-cause mortality 55. Restarting OAC was associated with an increased risk of a recurrent major bleeding (OR 1.85), although no increased risk of recurrence of the index bleeding event (ie, ICH or GI-bleeding) was observed.…”

“…However, there is substantial controversy regarding the optimal time period for re-initiation 58–60. A pooled analysis of the retrospective AF studies of Kuramatsu et al, and Nielsen et al, showed that OAC restarters had a lower rate of any thromboembolic event (HR 0.45 [95% CI 0.26–0.78]), and that OAC resumption was not significantly associated with recurrent major bleeding (HR 1.65 [95% CI 0.97–2.79]) 55,61,62. In a model with any thromboembolic event, major bleeding, and all-cause mortality, OAC resumption after ICH resulted in a positive NCB 55.…”

Association Between Peripheral Artery Disease and Incident Risk of Atrial Fibrillation: Strong Evidence Coming From Population‐Based Cohort Studies

“…Bayesian meta-analyses under heterogeneity were conducted by means of hierarchical (log-) gaussian models with informative priors, according to previously published articles. 10 For meta-regression, a linear model was assumed for the pooled location estimates. For curve pooling, one meta-analysis was conducted for each point in a grid and the resulting pooled estimates were then smoothed by means of lowest regression.…”