Risk factors for anticoagulation-related bleeding complications in patients with atrial fibrillation: a systematic review
Abstract
Atrial fibrillation (AF) is associated with an increased stroke risk that may be reduced by therapeutic anticoagulation. However, anticoagulation is associated with an increased risk of bleeding that in some patients may outweigh the benefits in reducing the risk of stroke. We systematically reviewed the literature for risk factors of anticoagulation-related bleeding complications in patients with AF, as part of the formulation of recently published national guidelines for the management of AF. We identified nine studies that reported anticoagulation-related bleeding complications in AF patients. The following patient characteristics were identified as having supporting evidence for being risk factors for anticoagulation-related bleeding complications: advanced age, uncontrolled hypertension, history of myocardial infarction or ischaemic heart disease, cerebrovascular disease, anaemia or a history of bleeding, and the concomitant use of other drugs such as antiplatelet agents. The presence of diabetes mellitus, controlled hypertension and gender were not identified as significant risk factors. Some of the risk factors for anticoagulation-related bleeding are also indications for the use of anticoagulants in AF patients. There is a need for further research in this area to help physicians to balance the risks and benefits of anticoagulation in AF patients.
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Bleeding risk on anticoagulation is similar in both sexes.
“Bleeding risk on anticoagulation is similar in both sexes, 49,50,53 but women appear less likely to receive specialist care and rhythm control therapy, 54 while the outcomes of catheter ablation or AF surgery are comparable to those in men.55,56”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [53]
Uncontrolled blood pressure increases the risk of bleeding on oral anticoagulation.
“Uncontrolled blood pressure increases the risk of bleeding on OAC.53”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [53]
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- Authors
- Hughes, M., Lip, G. Y. H., & on behalf of the Guideline Development Group for the NICE national clinical guideline for management of atrial fibrillation in primary and secondary care
- Affiliations
- Royal College of Physicians (GB)
- Birmingham City Hospital (GB)
- ORCID
- Lip, G.Y.H.
- Venue
- QJM
- Publisher
- Oxford University Press (OUP)
- Published
- 2007-09-19
- Volume
- 100
- Issue
- 10
- Pages
- 599-607
- ISSN
- 0033-5622 (ISSN-L)
- 1460-2725
- 1460-2393
- OpenAlex
- W2128635858
- Cited by
- 217
- References
- 36
- Citations by year
- 2025: 1 · 2024: 5 · 2023: 4 · 2022: 13 · 2021: 8 · 2020: 4 · 2019: 11 · 2018: 12 · 2017: 12 · 2016: 13 · 2015: 5 · 2014: 11 · 2013: 23 · 2012: 28
- FWCI
- 2.42
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- QJM (publishedVersion)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Funders
- National Institutes of Health
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Keywords
- atrial fibrillation, anticoagulation, bleeding complications, risk factors, stroke prevention, antiplatelet agents, hypertension, myocardial infarction, anemia, old age, concomitant drug use, benefits and risks
- MeSH terms
- Age Factors, Anticoagulants, Atrial Fibrillation, Female, Hemorrhage, Humans, Male, Risk Factors, Sex Factors
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