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Aortic valve stenosis provides complementary information to bleeding risk scores in non-valvular atrial fibrillation patients initiating anticoagulation

BACKGROUND: The identification of modifiable bleeding risk factors may be of relevance. The aim is to evaluate if aortic stenosis (AS) provides additional information to bleeding risk scores for predicting major bleeding (MB) in non-valvular atrial fibrillation (AF). METHODS: We designed a retrospec...

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Autores principales: Elvira-Ruiz, Ginés, Caro-Martínez, César, Flores-Blanco, Pedro José, Cerezo-Manchado, Juan José, Albendín-Iglesias, Helena, Lova-Navarro, Alejandro, Arregui-Montoya, Francisco, Muñoz-Franco, Francisca María, García-Iniesta, Natalia, García-Alberola, Arcadio, Bailén-Lorenzo, José Luis, Pascual-Figal, Domingo Andrés, Manzano-Fernández, Sergio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Science Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7118015/
https://www.ncbi.nlm.nih.gov/pubmed/32280330
http://dx.doi.org/10.11909/j.issn.1671-5411.2020.03.005
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author Elvira-Ruiz, Ginés
Caro-Martínez, César
Flores-Blanco, Pedro José
Cerezo-Manchado, Juan José
Albendín-Iglesias, Helena
Lova-Navarro, Alejandro
Arregui-Montoya, Francisco
Muñoz-Franco, Francisca María
García-Iniesta, Natalia
García-Alberola, Arcadio
Bailén-Lorenzo, José Luis
Pascual-Figal, Domingo Andrés
Manzano-Fernández, Sergio
author_facet Elvira-Ruiz, Ginés
Caro-Martínez, César
Flores-Blanco, Pedro José
Cerezo-Manchado, Juan José
Albendín-Iglesias, Helena
Lova-Navarro, Alejandro
Arregui-Montoya, Francisco
Muñoz-Franco, Francisca María
García-Iniesta, Natalia
García-Alberola, Arcadio
Bailén-Lorenzo, José Luis
Pascual-Figal, Domingo Andrés
Manzano-Fernández, Sergio
author_sort Elvira-Ruiz, Ginés
collection PubMed
description BACKGROUND: The identification of modifiable bleeding risk factors may be of relevance. The aim is to evaluate if aortic stenosis (AS) provides additional information to bleeding risk scores for predicting major bleeding (MB) in non-valvular atrial fibrillation (AF). METHODS: We designed a retrospective multi-center study including 2880 consecutive non-valvular AF patients initiating oral anticoagulation between January 2013 and December 2016. AS was defined as moderate or severe according to European echocardiography guidelines criteria. HASBLED, ATRIA and ORBIT scores were used to evaluate the bleeding risk. MB was defined according to the International Society on Thrombosis and Haemostasia criteria and registered at 18 months of follow-up. RESULTS: 168 (5.8%) patients had AS. Patients with AS had higher risk for MB compared to those without AS (HR = 2.13, 95% CI: 1.40–3.23, P < 0.001). Patients without AS and low-intermediate bleeding risk (0 points) showed the lowest MB rate, whereas the MB rate observed among patients with AS and high bleeding risk (2 points) was the highest one. Discrimination and reclassification analyses showed that AS provided additional information to bleeding risk scores for predicting MB at 18 months of follow-up. CONCLUSIONS: In this population, AS was associated with an increased risk for MB at midterm follow-up. The three scoring systems showed a moderate discriminatory ability for MB. Moreover, the addition of AS was associated with a significant improvement in their predictive accuracy. We suggest that the presence of this valvulopathy should be taken into account for bleeding risk assessment.
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spelling pubmed-71180152020-04-10 Aortic valve stenosis provides complementary information to bleeding risk scores in non-valvular atrial fibrillation patients initiating anticoagulation Elvira-Ruiz, Ginés Caro-Martínez, César Flores-Blanco, Pedro José Cerezo-Manchado, Juan José Albendín-Iglesias, Helena Lova-Navarro, Alejandro Arregui-Montoya, Francisco Muñoz-Franco, Francisca María García-Iniesta, Natalia García-Alberola, Arcadio Bailén-Lorenzo, José Luis Pascual-Figal, Domingo Andrés Manzano-Fernández, Sergio J Geriatr Cardiol Research Article BACKGROUND: The identification of modifiable bleeding risk factors may be of relevance. The aim is to evaluate if aortic stenosis (AS) provides additional information to bleeding risk scores for predicting major bleeding (MB) in non-valvular atrial fibrillation (AF). METHODS: We designed a retrospective multi-center study including 2880 consecutive non-valvular AF patients initiating oral anticoagulation between January 2013 and December 2016. AS was defined as moderate or severe according to European echocardiography guidelines criteria. HASBLED, ATRIA and ORBIT scores were used to evaluate the bleeding risk. MB was defined according to the International Society on Thrombosis and Haemostasia criteria and registered at 18 months of follow-up. RESULTS: 168 (5.8%) patients had AS. Patients with AS had higher risk for MB compared to those without AS (HR = 2.13, 95% CI: 1.40–3.23, P < 0.001). Patients without AS and low-intermediate bleeding risk (0 points) showed the lowest MB rate, whereas the MB rate observed among patients with AS and high bleeding risk (2 points) was the highest one. Discrimination and reclassification analyses showed that AS provided additional information to bleeding risk scores for predicting MB at 18 months of follow-up. CONCLUSIONS: In this population, AS was associated with an increased risk for MB at midterm follow-up. The three scoring systems showed a moderate discriminatory ability for MB. Moreover, the addition of AS was associated with a significant improvement in their predictive accuracy. We suggest that the presence of this valvulopathy should be taken into account for bleeding risk assessment. Science Press 2020-03 /pmc/articles/PMC7118015/ /pubmed/32280330 http://dx.doi.org/10.11909/j.issn.1671-5411.2020.03.005 Text en Institute of Geriatric Cardiology http://creativecommons.org/licenses/by-nc-sa/3.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License, which allows readers to alter, transform, or build upon the article and then distribute the resulting work under the same or similar license to this one. The work must be attributed back to the original author and commercial use is not permitted without specific permission.
spellingShingle Research Article
Elvira-Ruiz, Ginés
Caro-Martínez, César
Flores-Blanco, Pedro José
Cerezo-Manchado, Juan José
Albendín-Iglesias, Helena
Lova-Navarro, Alejandro
Arregui-Montoya, Francisco
Muñoz-Franco, Francisca María
García-Iniesta, Natalia
García-Alberola, Arcadio
Bailén-Lorenzo, José Luis
Pascual-Figal, Domingo Andrés
Manzano-Fernández, Sergio
Aortic valve stenosis provides complementary information to bleeding risk scores in non-valvular atrial fibrillation patients initiating anticoagulation
title Aortic valve stenosis provides complementary information to bleeding risk scores in non-valvular atrial fibrillation patients initiating anticoagulation
title_full Aortic valve stenosis provides complementary information to bleeding risk scores in non-valvular atrial fibrillation patients initiating anticoagulation
title_fullStr Aortic valve stenosis provides complementary information to bleeding risk scores in non-valvular atrial fibrillation patients initiating anticoagulation
title_full_unstemmed Aortic valve stenosis provides complementary information to bleeding risk scores in non-valvular atrial fibrillation patients initiating anticoagulation
title_short Aortic valve stenosis provides complementary information to bleeding risk scores in non-valvular atrial fibrillation patients initiating anticoagulation
title_sort aortic valve stenosis provides complementary information to bleeding risk scores in non-valvular atrial fibrillation patients initiating anticoagulation
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7118015/
https://www.ncbi.nlm.nih.gov/pubmed/32280330
http://dx.doi.org/10.11909/j.issn.1671-5411.2020.03.005
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