Bleeding Tolerance Among Patients With Atrial Fibrillation on Oral Anticoagulation

Background: Oral anticoagulation increases the bleeding risk. We investigated how clinical factors and the level of atrial fibrillation (AF) knowledge affect the bleeding acceptance in patients with AF.

Methods: In 173 consecutive anticoagulated outpatients with AF (aged 68.7 ± 10.7 years, 39.3% male), the bleeding ratio was assessed based on the declared maximum number of major bleeds the people were willing to endure to avert 1 stroke. The Jessa AF Knowledge Questionnaire was used to assess the knowledge of AF.

Results: Compared with patients with the high bleeding ratio (≥ 4 accepted bleedings, n = 88, 50.9%), subjects with the low bleeding ratio (0-3 accepted bleedings, n = 85, 49.1%) were older, with longer duration of AF, suffered more commonly from heart failure, and were free of cerebrovascular events. Patients after major bleeding (n = 33, 19.1%) and those reporting minor bleeds on anticoagulation (n = 77, 44.5%) had lower bleeding ratio. The independent predictors of the low bleeding ratio were older age (odds ratio [OR], 2.50; 95% confidence interval [CI], 1.69-3.70), major bleeds on anticoagulation (OR, 3.33; 95% CI, 1.16-10.0), minor bleeds on anticoagulation (OR, 3.45; 95% CI, 1.67-7.14), and prior stroke/transient ischemic attack (OR, 0.47; 95% CI, 0.22-0.99). The level of knowledge of AF did not affect the bleeding ratio.

Conclusions: The key determinants of the bleeding ratio among anticoagulated patients with AF are age, and prior thromboembolic and bleeding episodes. The study could support identification of patients with AF who need additional effort to increase their acceptance of a life-long oral anticoagulation therapy.