W Frank Peacock1, Sally Tamayo2, Manesh Patel3, Nicholas Sicignano4, Kathleen P Hopf4, Zhong Yuan5. 1. Department of Emergency Medicine, Baylor College of Medicine, Houston, TX. Electronic address: frankpeacock@gmail.com. 2. Department of Cardiology, Marine Corps, United States Navy, Naval Medical Center, Portsmouth, VA. 3. Duke University Health System and Duke Clinical Research Institute, Durham, NC. 4. Clinical Epidemiology, Health ResearchTx, LLC, Trevose, PA. 5. Janssen Research and Development, LLC, Titusville, NJ.
Abstract
STUDY OBJECTIVE: Assessing stroke risk associated with nonvalvular atrial fibrillation depends on the evaluation of patient characteristics and clinical features. Clinicians must determine that the net clinical benefit from anticoagulation therapy outweighs its risk, namely, bleeding. Risk assessment for stroke is commonly performed by calculating a CHA2DS2-VASc (congestive heart failure/left ventricular dysfunction, hypertension, ≥75 years, diabetes mellitus, previous stroke or transient ischemic attack or thromboembolism, vascular disease, aged 65 to 74 years, sex female) score. It is possible that CHA2DS2-VASc scores also have a relationship with the incidence of major bleeding. We examined the relationship between CHA2DS2-VASc scores and major bleeding in rivaroxaban users with nonvalvular atrial fibrillation. METHODS: Electronic medical records of more than 10 million patients from the Department of Defense Military Health System were queried to identify patients with nonvalvular atrial fibrillation who received rivaroxaban from January 1, 2013, to June 30, 2015. Baseline characteristics of the study population were described by CHA2DS2-VASc scores and major bleeding status; major bleeding incidence was evaluated by CHA2DS2-VASc score category and for each CHA2DS2-VASc component. RESULTS: Overall, 44,793 patients met the inclusion criteria for this analysis. The major bleeding incidence rate was 2.84 (95% confidence interval 2.69 to 3.00) per 100 person-years. The incidence of major bleeding increased from 0.30 to 5.40 per 100 person-years among patients with a CHA2DS2-VASc score of 0 to 5 or higher, respectively. Fatal outcomes among patients with major bleeding were positively correlated with CHA2DS2-VASc scores; patients with higher scores had higher mortality rates. The CHA2DS2-VASc component with the highest major bleeding incidence was for vascular disease, 5.69 (95% confidence interval 5.18 to 6.24) per 100 person-years. CONCLUSION: Higher CHA2DS2-VASc scores are associated with increased incidence of major bleeding in nonvalvular atrial fibrillation patients receiving rivaroxaban.
STUDY OBJECTIVE: Assessing stroke risk associated with nonvalvular atrial fibrillation depends on the evaluation of patient characteristics and clinical features. Clinicians must determine that the net clinical benefit from anticoagulation therapy outweighs its risk, namely, bleeding. Risk assessment for stroke is commonly performed by calculating a CHA2DS2-VASc (congestive heart failure/left ventricular dysfunction, hypertension, ≥75 years, diabetes mellitus, previous stroke or transient ischemic attack or thromboembolism, vascular disease, aged 65 to 74 years, sex female) score. It is possible that CHA2DS2-VASc scores also have a relationship with the incidence of major bleeding. We examined the relationship between CHA2DS2-VASc scores and major bleeding in rivaroxaban users with nonvalvular atrial fibrillation. METHODS: Electronic medical records of more than 10 million patients from the Department of Defense Military Health System were queried to identify patients with nonvalvular atrial fibrillation who received rivaroxaban from January 1, 2013, to June 30, 2015. Baseline characteristics of the study population were described by CHA2DS2-VASc scores and major bleeding status; major bleeding incidence was evaluated by CHA2DS2-VASc score category and for each CHA2DS2-VASc component. RESULTS: Overall, 44,793 patients met the inclusion criteria for this analysis. The major bleeding incidence rate was 2.84 (95% confidence interval 2.69 to 3.00) per 100 person-years. The incidence of major bleeding increased from 0.30 to 5.40 per 100 person-years among patients with a CHA2DS2-VASc score of 0 to 5 or higher, respectively. Fatal outcomes among patients with major bleeding were positively correlated with CHA2DS2-VASc scores; patients with higher scores had higher mortality rates. The CHA2DS2-VASc component with the highest major bleeding incidence was for vascular disease, 5.69 (95% confidence interval 5.18 to 6.24) per 100 person-years. CONCLUSION: Higher CHA2DS2-VASc scores are associated with increased incidence of major bleeding in nonvalvular atrial fibrillationpatients receiving rivaroxaban.
Authors: Cheryl D Bushnell; Seemant Chaturvedi; Kathy R Gage; Paco S Herson; Patricia D Hurn; Monik C Jiménez; Steven J Kittner; Tracy E Madsen; Louise D McCullough; Mollie McDermott; Mathew J Reeves; Tatjana Rundek Journal: J Cereb Blood Flow Metab Date: 2018-08-17 Impact factor: 6.200