B Daan Westenbrink1, Marco Alings2, Christopher B Granger3, John H Alexander3, Renato D Lopes3, Elaine M Hylek4, Laine Thomas3, Daniel M Wojdyla3, Michael Hanna5, Matyas Keltai6, P Gabriel Steg7, Raffaele De Caterina8, Lars Wallentin9, Wiek H van Gilst10. 1. University Medical Center Groningen, University of Groningen, Groningen, Netherlands. Electronic address: b.d.westenbrink@umcg.nl. 2. Working Group on Cardiovascular Research, Utrecht, Netherlands. 3. Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. 4. Boston University School of Medicine, Boston, MA. 5. Bristol-Myers Squibb, Princeton, NJ. 6. Hungarian Institute of Cardiology, Budapest, Hungary. 7. DHU FIRE, Université Paris-Diderot, Hôpital Bichat, AP-HP, INSERM, Paris, France. 8. G. d'Annunzio Univ and Fondazione Toscana G. Monasterio, Chieti, Italy. 9. Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden. 10. University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
Abstract
BACKGROUND:Patients with atrial fibrillation (AF) are prone to cardiovascular events and anticoagulation-related bleeding complications. We hypothesized that patients with anemia are at increased risk for these outcomes. METHODS: We performed a post hoc analysis of the ARISTOTLE trial, which included >18,000 patients with AF randomized to warfarin (target international normalized ratio, 2.0-3.0) or apixaban 5 mg twice daily. Multivariable Cox regression analysis was used to determine if anemia (defined as hemoglobin <13.0 in men and <12.0 g/dL in women) was associated with future stroke, major bleeding, or mortality. RESULTS:Anemia was present at baseline in 12.6% of the ARISTOTLE population. Patients with anemia were older, had higher mean CHADS2 and HAS-BLED scores, and were more likely to have experienced previous bleeding events. Anemia was associated with major bleeding (adjusted hazard ratio [HR], 1.92; 95% CI, 1.62-2.28; P<.0001) and all-cause mortality (adjusted HR, 1.68; 95% CI, 1.46-1.93; P<.0001) but not stroke or systemic embolism (adjusted HR, 0.92; 95% CI, 0.70-1.21). The benefits of apixaban compared with warfarin on the rates of stroke, mortality, and bleeding events were consistent in patients with and without anemia. CONCLUSIONS:Chronic anemia is associated with a higher incidence of bleeding complications and mortality, but not of stroke, in anticoagulated patients with AF. Apixaban is an attractive anticoagulant for stroke prevention in patients with AF with or without anemia.
RCT Entities:
BACKGROUND:Patients with atrial fibrillation (AF) are prone to cardiovascular events and anticoagulation-related bleeding complications. We hypothesized that patients with anemia are at increased risk for these outcomes. METHODS: We performed a post hoc analysis of the ARISTOTLE trial, which included >18,000 patients with AF randomized to warfarin (target international normalized ratio, 2.0-3.0) or apixaban 5 mg twice daily. Multivariable Cox regression analysis was used to determine if anemia (defined as hemoglobin <13.0 in men and <12.0 g/dL in women) was associated with future stroke, major bleeding, or mortality. RESULTS:Anemia was present at baseline in 12.6% of the ARISTOTLE population. Patients with anemia were older, had higher mean CHADS2 and HAS-BLED scores, and were more likely to have experienced previous bleeding events. Anemia was associated with major bleeding (adjusted hazard ratio [HR], 1.92; 95% CI, 1.62-2.28; P<.0001) and all-cause mortality (adjusted HR, 1.68; 95% CI, 1.46-1.93; P<.0001) but not stroke or systemic embolism (adjusted HR, 0.92; 95% CI, 0.70-1.21). The benefits of apixaban compared with warfarin on the rates of stroke, mortality, and bleeding events were consistent in patients with and without anemia. CONCLUSIONS:Chronic anemia is associated with a higher incidence of bleeding complications and mortality, but not of stroke, in anticoagulated patients with AF. Apixaban is an attractive anticoagulant for stroke prevention in patients with AF with or without anemia.
Authors: Jevgenia Zilberman-Rudenko; Rachel M White; Dmitriy A Zilberman; Hari H S Lakshmanan; Rachel A Rigg; Joseph J Shatzel; Jeevan Maddala; Owen J T McCarty Journal: Cell Mol Bioeng Date: 2018-07-19 Impact factor: 2.321
Authors: Salva R Yurista; Herman H W Silljé; Michiel Rienstra; Rudolf A de Boer; B Daan Westenbrink Journal: Cardiovasc Diabetol Date: 2020-01-07 Impact factor: 9.951
Authors: Angela Lowenstern; Sana M Al-Khatib; Lauren Sharan; Ranee Chatterjee; Nancy M Allen LaPointe; Bimal Shah; Ethan D Borre; Giselle Raitz; Adam Goode; Roshini Yapa; J Kelly Davis; Kathryn Lallinger; Robyn Schmidt; Andrzej S Kosinski; Gillian D Sanders Journal: Ann Intern Med Date: 2018-10-30 Impact factor: 51.598