P6285Predictors of major bleeding in patients aged 90 years or over with atrial fibrillation on anticoagulant treatment

Abstract

Background: Decision-making for anticoagulation in atrial fibrillation (AF) needs to balance the risk of ischaemic stroke against the risk of major bleeding. The risk of bleeding remains a major concern of anticoagulant treatment in elderly patients. However, limited evidences are currently available on predictors of major bleeding in AF patients aged 90 years or older. Purpose: The aim of this study was to investigate for predictors of major bleeding in AF patients aged 90 years or over while on anticoagulant treatment. Methods: This multicenter cohort study enrolled AF patients aged 90 years or older treated with either vitamin-K antagonists (VKAs) or direct oral anticoagulants. Cox proportional hazard model was used to identify univariate predictors of major bleeding among the following: sex, age, type of anticoagulant, anticoagulation naïve, laboratory exams (haemoglobin and platelet values, Cockroft-Gault clearance), risk of falls, HAS-BLED and CHA2DS2-VASc score and their individual components. Multivariate analyses were constructed from the set of significant (p<0.50) univariable predictors. Results: Overall 526 patients were included. Major bleeding occurred in 44 patients (8.4%). Univariate predictors of major bleeding selected for multivariable analysis were female gender (OR 0.74, 95% CI 0.40-1.39, p=0.41), previous bleeding (OR 2.31, 95% CI 1.24-4.31, p=0.01), CHA2DS2-VASc >3 (OR 2.31, 95% CI 0.91-5.91, p=0.08), decreased Cockroft-Gault clearance (OR 1.27, 95% CI 0.83-1.93, p=0.27) and increasing age (OR 1.18, 95% CI 1.02-1.36, p=0.02). At multivariate analysis only previous bleeding (OR 3.28, 95% CI 1.68-6.39, p<0.001) and increasing age (OR 1.23, 95% CI 1.05-1.43, p=0.01) were independently associated with major bleeding. No association was found between major bleeding and risk of falls. Conclusions: Increasing age and previous bleeding were independent predictors for major bleeding in AF patients aged 90 years or older on anticoagulation.