Risk of bleeding in low-risk atrial fibrillation patients on warfarin waiting for elective cardioversion
Thrombosis Research, 05/01/2012
Clinical Article
Poli D et al. – The results show that low–risk atrial fibrillation patients, treated with vitamin K antagonist for elective cardioversion, carry a not irrelevant risk of bleeding. Efforts are required to properly select patients who could benefit from this procedure, reducing the time of warfarin exposure.
Methods- The authors performed a prospective multicentre study on 242 low–risk AF patients (CHADS2 score 0–1) that started on warfarin for elective cardioversion to evaluate their bleeding risk.
- 178 were males (73.6%), mean age 63.9±9.8years, 60 patients (25%) were aged ≤59years.
- Patients with CHADS2 score=0 were 73 (30%), those with CHADS2 score=1 were 169 (70%).
- Patients were on VKA treatment, maintained at INR intended therapeutic range 2.0–3.0, for a median time of 159days (range 30–631)total follow–up period 127 patient–years (pt–yrs).
- Quality of anticoagulation and occurrence of bleeding events were recorded.
- Patients spent 23%, 64% and 8% of time below, within and above the intended therapeutic range, respectively.
- When the authors observed the INR levels, the authors found that 62 patients (25.6%) had INR>4.5 at least in one occasion, and 23 (9.5%) in ≥2.
- During follow–up, 2 patients had major bleeds (rate 1.6% pt–yrs), one fatal.
- No embolic complications were recorded.
