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Aortic valve stenosis provides complementary information to bleeding risk scores in non-valvular atrial fibrillation patients initiating anticoagulation

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Journal of Geriatric Cardiology 2020年第3期17卷 141-148,I0005-I0007页

作者： Gines Elvira-Ruiz cesar caro-martinez Pedro JoseFlores-Blanco Juan JoseCerezo-Manchado Helena Albendin-Iglesias Alejandro Lova-Navarro Francisco Arregui-Montoya Francisca Maria Munoz-Franco Natalia Garcia-Iniesta Arcadio Garcia-Alberola JoseLuis Bailen-Lorenzo Domingo Andres Pascual-Figal Sergio Manzano-Fernández Department of Cardiology University Hospital Virgen de la ArrixacaMurciaSpain Instituto Murciano de Investigación en Biomedicina(IMIB) MurciaSpain Department of Cardiology University Hospital Morales MeseguerMurciaSpain Department of Hematology University Hospital Virgen de la ArrixacaMurciaSpain Department of Internal Medicine University Hospital Virgen de la ArrixacaMurciaSpain School of Medicine University of MurciaMurciaSpain Department of Cardiology Hospital Vega BajaAlicanteSpain

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.

关键词： Anticoagulants Aortic stenosis Atrial fibrillation Major bleeding Valvular disease

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