Oral anticoagulation therapy in atrial fibrillation patients at high risk of bleeding: Clinical characteristics and treatment strategies based on data from the Polish Multi-center Register of Atrial Fibrillation (POL-AF)

Background: Despite its benefits, oral anticoagulant (OAC) therapy in patients with atrial fibrillation (AF) is associated with hemorrhagic complications. Aims: We aimed to evaluate clinical characteristics of AF patients at high risk of bleeding and the frequency of OAC use as well as identify factors that predict nonuse of OACs in these patients. Methods: Consecutive AF patients hospitalized for urgent or planned reasons in cardiac centers were prospectively included in the registry in 2019. Patients with HAS-BLED ≥3 (high HAS-BLED group) were assumed to have a high risk of bleeding. Results: Among 3598 patients enrolled in the study, 29.2% were at high risk of bleeding (44.7% female; median [Q1–Q3] age 72 [65–81], CHA ₂DS ₂-VASc score 5 [4–6], HAS-BLED 3 [3–4]). In this group, 14.5% of patients did not receive OACs, 68% received NOACs, and 17.5% VKAs. In multivariable analysis, the independent predictors of nonuse of oral OACs were as follows: creatinine level (odds ratio [OR], 1.441; 95% confidence interval [CI], 1.174–1.768; P <0.001), a history of gastrointestinal bleeding (OR, 2.918; 95% CI, 1.395–6.103; P = 0.004), malignant neoplasm (OR, 3.127; 95% CI, 1.332–7.343; P = 0.009), and a history of strokes or transient ischemic attacks (OR, 0.327; 95% CI, 0.166–0.642; P = 0.001). Conclusions: OACs were used much less frequently in the group with a high HAS-BLED score than in the group with a low score. Independent predictors of nonuse of OACs were creatinine levels, a history of gastrointestinal bleeding, and malignant neoplasms. A history of stroke or transient ischemic attack increased the chances of receiving therapy.