Resumption of anticoagulant therapy after major bleeding and the risk of negative events in patients with atrial fibrillation (based on REGistry of Long-term AnTithrombotic TherApy-2 – REGATA)

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Abstract

Background. It is necessary to strive to resume anticoagulants for patients with atrial fibrillation who have a high risk of thrombosis after the development of large bleeding. Due to the fact that death in these patients is caused not by a recurrence of fatal bleeding, but by the development of stroke in case of refusal of anticoagulant therapy.

Aim. To evaluate the effect of the resumption of anticoagulant therapy on the risk of recurrence of major bleeding, thrombosis and death in patients with atrial fibrillation who have suffered major bleeding.

Materials and methods. To evaluate the frequency of bleeding, thrombosis and death in patients with atrial fibrillation after major bleeding according to prospective follow-up data for one year.

Results. The recurrence rate of major bleeding after the resumption of therapy was 21.7% per year. The frequency of fatal bleeding was 2.2%. In the anticoagulant withdrawal group, the incidence of thrombotic complications (ischemic stroke and myocardial infarction) was significantly higher compared to patients who resumed therapy. The frequency of death from all causes was significantly higher in the group of patients who did not resume anticoagulant therapy. Half of the deaths were due to cardiovascular causes. The presence of more than 5 points of the Charlson Comorbidity Index was a predictor of the development of the sum of all adverse events.

Conclusion. The resumption of anticoagulant therapy after the development of major bleeding in patients with atrial fibrillation reduces the risk of thrombosis and death at a cost, while increasing the risk of recurrence of non-fatal bleeding.

About the authors

Ekaterina S. Kropacheva

Chazov National Medical Research Center of Cardiology

Author for correspondence.
Email: KateKrab@list.ru
ORCID iD: 0000-0002-3092-8593

канд. мед. наук, ст. науч. сотр. отд. клинических проблем атеротромбоза

Russian Federation, Moscow

Oxana A. Zemlyanskaya

Chazov National Medical Research Center of Cardiology

Email: KateKrab@list.ru
ORCID iD: 0000-0003-4035-2943

канд. мед. наук, науч. сотр. отд. клинических проблем атеротромбоза

Russian Federation, Moscow

Elena N. Krivosheeva

Chazov National Medical Research Center of Cardiology

Email: KateKrab@list.ru
ORCID iD: 0000-0003-1146-9974

канд. мед. наук, мл. науч. сотр. отд. клинических проблем атеротромбоза

Russian Federation, Moscow

Elizaveta P. Panchenko

Chazov National Medical Research Center of Cardiology

Email: KateKrab@list.ru
ORCID iD: 0000-0002-9158-2522

д-р мед. наук., проф., рук. отд. клинических проблем атеротромбоза

Russian Federation, Moscow

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Supplementary files

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2. Fig. 1. The proportion of patients who survived the follow-up period without recurrence of major bleeding in the groups who resumed and did not resume anticoagulant therapy (a) and depending on the change of anticoagulant (b).

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3. Fig. 2. The proportion of patients who survived the observation period without the development of a thrombotic event (а) and death from all causes (b) in the groups who resumed and did not resume anticoagulant therapy (Kaplan–Meyer curves).

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4. Fig. 3. The proportion of patients who survived the follow-up period without the development of the sum of all prognostic events (major bleeding, thrombotic complications and death from any cause), depending on the Charlson comorbidity index (Kaplan–Meyer curves).

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