Daniele Pastori1, Gregory Y H Lip2, Alessio Farcomeni3, Francesco Del Sole4, Angela Sciacqua5, Francesco Perticone5, Rossella Marcucci6, Elisa Grifoni6, Pasquale Pignatelli4, Francesco Violi7. 1. I Clinica Medica, Atherothrombosis Centre, Department of Internal Medicine and Medical Specialties of Sapienza University of Rome, Rome, Italy; Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom. 2. Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom. 3. Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy. 4. I Clinica Medica, Atherothrombosis Centre, Department of Internal Medicine and Medical Specialties of Sapienza University of Rome, Rome, Italy. 5. Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy. 6. Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy. 7. I Clinica Medica, Atherothrombosis Centre, Department of Internal Medicine and Medical Specialties of Sapienza University of Rome, Rome, Italy. Electronic address: francesco.violi@uniroma1.it.
Abstract
OBJECTIVES: To investigate the incidence of bleeding events in atrial fibrillation (AF) patients treated with vitamin K (VKAs) or non-vitamin K antagonist oral anticoagulants (NOACs) screened for the presence of liver fibrosis (LF). BACKGROUND: Previous studies provided conflicting results on bleeding risk in AF patients with liver disease on VKAs, and no data on NOACs in this setting are available. METHODS: Post-hoc analysis of a prospective, observational multicentre study including 2330 AF outpatients treated with VKAs (n = 1297) or NOACs (n = 1033). Liver damage was quantified by the FIB-4 score (>3.25), a validated marker of LF. The primary endpoint was the incidence of any bleeding, according to ISTH classification. RESULTS: A high FIB-4 was present in 129 (5.5%) patients: 77 (5.9%) on VKA and 52 (5.0%) on NOACs (p = 0.344). During follow-up, 357 (15.3%) patients experienced a bleeding: 261 (80 major and 180 minor) with VKAs (7.2%/year), and 96 (40 major and 56 minor) with NOACs (6.4%/year). In VKA-treated patients, but not in those on NOACs, FIB-4 >3.25 was associated with higher major bleeding (14.3% vs. 5.6%, log-rank test p < 0.001). Multivariable Cox regression model showed that FIB-4 was associated with major bleeding only in VKA-treated patients (HR: 3.075, 95% CI 1.626-5.818, p = 0.001). On multivariable analysis, FIB-4 was not significantly associated with CVEs neither in VKA or NOAC-treated patients. CONCLUSION: We found a significant association between LF and major bleedings in AF patients treated with VKA, which was not evident in patients on NOACs.
OBJECTIVES: To investigate the incidence of bleeding events in atrial fibrillation (AF) patients treated with vitamin K (VKAs) or non-vitamin K antagonist oral anticoagulants (NOACs) screened for the presence of liver fibrosis (LF). BACKGROUND: Previous studies provided conflicting results on bleeding risk in AFpatients with liver disease on VKAs, and no data on NOACs in this setting are available. METHODS: Post-hoc analysis of a prospective, observational multicentre study including 2330 AF outpatients treated with VKAs (n = 1297) or NOACs (n = 1033). Liver damage was quantified by the FIB-4 score (>3.25), a validated marker of LF. The primary endpoint was the incidence of any bleeding, according to ISTH classification. RESULTS: A high FIB-4 was present in 129 (5.5%) patients: 77 (5.9%) on VKA and 52 (5.0%) on NOACs (p = 0.344). During follow-up, 357 (15.3%) patients experienced a bleeding: 261 (80 major and 180 minor) with VKAs (7.2%/year), and 96 (40 major and 56 minor) with NOACs (6.4%/year). In VKA-treated patients, but not in those on NOACs, FIB-4 >3.25 was associated with higher major bleeding (14.3% vs. 5.6%, log-rank test p < 0.001). Multivariable Cox regression model showed that FIB-4 was associated with major bleeding only in VKA-treated patients (HR: 3.075, 95% CI 1.626-5.818, p = 0.001). On multivariable analysis, FIB-4 was not significantly associated with CVEs neither in VKA or NOAC-treated patients. CONCLUSION: We found a significant association between LF and major bleedings in AFpatients treated with VKA, which was not evident in patients on NOACs.
Authors: Marina Serper; Ethan M Weinberg; Jordana B Cohen; Peter P Reese; Tamar H Taddei; David E Kaplan Journal: Hepatology Date: 2020-11-09 Impact factor: 17.425
Authors: Daniele Pastori; Gregory Y H Lip; Alessio Farcomeni; Francesco Del Sole; Angela Sciacqua; Francesco Perticone; Rossella Marcucci; Elisa Grifoni; Pasquale Pignatelli; Francesco Violi Journal: Data Brief Date: 2018-02-06
Authors: Neal S Parikh; Hooman Kamel; Babak B Navi; Costantino Iadecola; Alexander E Merkler; Arun Jesudian; Jesse Dawson; Guido J Falcone; Kevin N Sheth; David J Roh; Mitchell S V Elkind; Daniel F Hanley; Wendy C Ziai; Santosh B Murthy Journal: Stroke Date: 2020-01-07 Impact factor: 7.914
Authors: Sarah A Nisly; Alexandra E Mihm; Chris Gillette; Kyle A Davis; Janine Tillett Journal: J Thromb Thrombolysis Date: 2021-03-16 Impact factor: 2.300