Risk Factors for Intracranial Bleeding in Older Patients with Atrial Fibrillation Who Are on Anticoagulants

MARCH 18, 2016
Andrew Smith
A large retrospective analysis concludes that an unexpectedly high rate of serious bleeds may contraindicate warfarin use in some groups of older patients with atrial fibrillation (AFib).
Investigators examined medical records from 31,951 veterans aged 75 years and older who began using the anticoagulant between January 1, 2002, and December 31, 2012. The mean patient age was 81.1 years at baseline (standard deviation: ± 4.1 years), 98.1% of the patients were male and the mean follow-up time was 2.97 years. Common comorbidities included hypertension (82.5%), coronary artery disease (42.6%), and diabetes mellitus (33.8%).
The overall rate of hospitalization for ischemic stroke was 13.44 per 1,000 person-years, while the overall rate of hospitalization for any type of intracranial bleeding was 14.58 per 1,000 person-years and the overall rate of hospitalization for traumatic intracranial bleeding was 4.80 per 1,000 person years.
Certain patient groups, however, were significantly more likely than average to suffer from those traumatic bleeds. After adjusting for potential confounders, the investigators found 5 significant predictors of traumatic intracranial bleeding: dementia (hazard ratio [HR], 1.76; 95% CI, 1.26-2.46), anemia (HR, 1.23; 95% CI, 1.00-1.52), depression (HR, 1.30; 95% CI, 1.05-1.61), anticonvulsant use (HR, 1.35; 95% CI, 1.04-1.75), and labile international normalized ratio (HR, 1.33; 95% CI, 1.04-1.72).
“Among patients 75 years or older with atrial fibrillation initiating warfarin therapy, the risk factors for traumatic intracranial bleeding are unique from those for ischemic stroke,” the study authors wrote in JAMA Cardiology. “The high overall rate of intracranial bleeding in our sample supports the need to more systematically evaluate the benefits and harms of warfarin therapy in older adults.”

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