Abstract
Objective
Hemoglobin levels and platelet counts have been associated with adverse clinical outcomes
in patients with cardiovascular conditions. We aimed to assess the impact of oral
anticoagulant use for patients with atrial fibrillation and concomitant anemia or
thrombocytopenia.
Methods
We used medical data from a multicenter health care system in Taiwan including 37,074
patients with atrial fibrillation. Patients were categorized into 3 groups based on
hemoglobin and platelet levels: Group 1 (hemoglobin >10g/dL and platelet>100 K/µL; n = 29,147), Group 2 (hemoglobin<10 g/dL or platelet<100 K/µL; n = 7078), and Group 3 (hemoglobin <10 g/dL and platelet <100 K/µL; n = 849). Patients in each category were further stratified as
3 groups according to their stroke prevention strategies: no oral anticoagulant use
(non-OAC), warfarin, or nonvitamin K antagonist oral anticoagulants (NOACs).
Results
A higher hemoglobin or platelet level was associated with a higher risk of ischemic
stroke/systemic embolism but lower risks of intracranial hemorrhage and major bleeding.
The composite risks of ischemic stroke/systemic embolism, intracranial hemorrhage
and major bleeding were higher in Group 3 or Group 2, compared with Group 1 (6.79%
a year vs 6.41% year vs 4.13% year). Compared to non-OACs, warfarin was not associated
with a lower composite risk in the 3 groups. NOACs were associated with a lower composite
risk in Group 1 (adjusted hazard ratio:0.68, [95% confidence interval:0.60-0.76])
and Group 2 (adjusted hazard ratio:0.73, [95% confidence interval:0.53-0.99]) but
was nonsignificant in Group 3.
Conclusions
Patients with atrial fibrillation with anemia or thrombocytopenia were a high-risk
population. Compared with no OAC use, NOACs were associated with better clinical outcomes
for patients with atrial fibrillation and advanced anemia (hemoglobin <10g/dL) or
thrombocytopenia (platelet <100 K/µL) but not for those with both conditions.
Keywords
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Article Info
Publication History
Published online: April 02, 2022
Footnotes
Funding: This study was supported by grants 105-2628-B-182A-003-MY3 from the Ministry of Science and Technology and grants CMRPG3E1681-3, CORPG3J0291-3 and CORPG3G0351 from Chang Gung Memorial Hospital, Linkou, Taiwan. This work was supported in part by grants from the Ministry of Science and Technology (MOST 107-2314-B-075-062-MY3), Taipei Veterans General Hospital (V108B-015, V108B-027, V108C-090, V109C-042, and V109C-186), and the Research Foundation of Cardiovascular Medicine and Szu-Yuan Research Foundation of Internal Medicine, Taipei, Taiwan. The Maintenance Project of the Center for Big Data Analytics and Statistics (Grant CLRPG3D0046 ) at Chang Gung Memorial Hospital for study design and monitor, data analysis, and interpretation.
Conflicts of Interest: None.
Authorship: All authors had access to the data and a role in writing this manuscript.
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