Stable international normalised ratio (INR) avoiding exposure to anti-platelet agents or non-steroidal anti-inflammatory drugs (NSAIDs) and preventing liver disease could reduce both bleeding and residual stroke risk in anticoagulated patients with atrial fibrillation (AF), according to research published in the BMJ Open.
For the study, researchers examined data on 5,310 patients receiving vitamin K antagonists (VKA) from the PREvention oF thromboembolic events-European Registry in AF (PREFER in AF) cohort to help identify risk factors for thromboembolic events and major bleeding. The findings were then validated using data on 3,156 patients receiving non-VKA oral anticoagulants (NOAC) from the PREFER in AF Prolongation cohort for stroke prevention in AF.
The study found abnormal liver function, prior stroke or transient ischaemic attack, labile INR, concomitant anti-platelet agents or NSAIDs, heart failure and older age (≥75 years) were independently associated with both thromboembolic and major bleeding events. With the exception of unstable INR values, these risk factors were validated in patients treated with NOACs.
“Attending to modifiable risk factors is an important treatment target in anticoagulated AF patients to reduce thromboembolic and bleeding events,” the authors said adding, “initiation of anticoagulation in those at risk of stroke should not be prevented by elevated bleeding risk scores."