Agnieszka Metzgier-Gumiela1, Grzegorz Skonieczny1, Małgorzata Konieczyńska2, Lien Desteghe3,4,5, Hein Heidbuchel3,4,5, Anetta Undas2,6. 1. Provincial Polyclinical Hospital, Toruń, Poland. 2. John Paul II Hospital, Krakow, Poland. 3. Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium. 4. Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium. 5. University of Antwerp and Antwerp University Hospital, Edegem, Belgium. 6. Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland.
Abstract
BACKGROUND: Anticoagulant therapy in patients with atrial fibrillation (AF) increases the risk of minor bleeding, which is mostly accepted by patients. We aimed to assess whether continuation of anticoagulation despite minor bleeding is associated with a higher level of knowledge on AF and anticoagulation. METHODS AND RESULTS: In 1525 patients with AF on oral anticoagulation who completed the Jessa AF Knowledge Questionnaire (JAKQ) (median age: 72 years [range, 65-79 years]; men: 54.6%), persistent self-reported minor bleeding was recorded. Minor bleeding was observed in 567 patients (37.2%) including 224 patients (39.5%) on vitamin K antagonists (VKAs) and 343 (60.5%) on non-vitamin K antagonist oral anticoagulants (NOACs). The risk of minor bleeding was lower among patients on NOACs than on VKAs (33.5% vs 44.6%; P < .0001). Multiple logistic regression showed that minor bleeding was associated with the use of NOACs (odds ratio [OR] 0.75; 95% CI 0.59-0.97), female gender (OR 2.19; 95% CI, 1.74-2.75; P < .0001), history of major bleeding (OR 2.85; 95% CI, 1.96-4.14; P < .0001), time since AF diagnosis (OR 1.04; 95% CI, 1.01-1.06; P < .0001), concomitant vascular disease (OR 1.43; 95% CI, 1.10-1.87; P = .0008) and diabetes mellitus (OR 1.3; 95% CI, 1.02-1.65, P = .03). Patients with minor bleeding, compared with the remaining subjects scored higher on the JAKQ (median, 62.5% vs 56.2%, respectively, P < .0001). The former group knew more about the purpose of anticoagulant therapy (71.8% vs 65.7%, P = .01) and bleeding as its key side effect (66.1% vs 52.7%, P < .0001), and were better informed on the safest painkillers to use in combination with anticoagulation (48% vs 35%, P < .0001). CONCLUSION: This study suggests that AF patients who accept persistent minor bleeding have better knowledge on the disease and anticoagulation therapy compared with those free of these side effects.
BACKGROUND: Anticoagulant therapy in patients with atrial fibrillation (AF) increases the risk of minor bleeding, which is mostly accepted by patients. We aimed to assess whether continuation of anticoagulation despite minor bleeding is associated with a higher level of knowledge on AF and anticoagulation. METHODS AND RESULTS: In 1525 patients with AF on oral anticoagulation who completed the Jessa AF Knowledge Questionnaire (JAKQ) (median age: 72 years [range, 65-79 years]; men: 54.6%), persistent self-reported minor bleeding was recorded. Minor bleeding was observed in 567 patients (37.2%) including 224 patients (39.5%) on vitamin K antagonists (VKAs) and 343 (60.5%) on non-vitamin K antagonist oral anticoagulants (NOACs). The risk of minor bleeding was lower among patients on NOACs than on VKAs (33.5% vs 44.6%; P < .0001). Multiple logistic regression showed that minor bleeding was associated with the use of NOACs (odds ratio [OR] 0.75; 95% CI 0.59-0.97), female gender (OR 2.19; 95% CI, 1.74-2.75; P < .0001), history of major bleeding (OR 2.85; 95% CI, 1.96-4.14; P < .0001), time since AF diagnosis (OR 1.04; 95% CI, 1.01-1.06; P < .0001), concomitant vascular disease (OR 1.43; 95% CI, 1.10-1.87; P = .0008) and diabetes mellitus (OR 1.3; 95% CI, 1.02-1.65, P = .03). Patients with minor bleeding, compared with the remaining subjects scored higher on the JAKQ (median, 62.5% vs 56.2%, respectively, P < .0001). The former group knew more about the purpose of anticoagulant therapy (71.8% vs 65.7%, P = .01) and bleeding as its key side effect (66.1% vs 52.7%, P < .0001), and were better informed on the safest painkillers to use in combination with anticoagulation (48% vs 35%, P < .0001). CONCLUSION: This study suggests that AFpatients who accept persistent minor bleeding have better knowledge on the disease and anticoagulation therapy compared with those free of these side effects.
Authors: Astrid N L Hermans; Monika Gawałko; Henrike A K Hillmann; Afzal Sohaib; Rachel M J van der Velden; Konstanze Betz; Dominique Verhaert; Daniel Scherr; Julia Meier; Arian Sultan; Daniel Steven; Elena Terentieva; Ron Pisters; Martin Hemels; Leonard Voorhout; Piotr Lodziński; Bartosz Krzowski; Dhiraj Gupta; Nikola Kozhuharov; Henri Gruwez; Kevin Vernooy; Nikki A H A Pluymaekers; Jeroen M Hendriks; Martin Manninger; David Duncker; Dominik Linz Journal: Front Cardiovasc Med Date: 2022-01-19