Nuisance bleeding on oral anticoagulation not associated with risk of major bleeding

Nuisance bleeding is common among atrial fibrillation patients on oral anticoagulation and is not associated with a higher risk of major bleeding, stroke, or systemic embolism within six months, a study found.

Researchers analyzed data on 6,771 adult patients with afib treated at 172 sites and included in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). Nuisance bleeding was ascertained from the medical record and was defined as minor bleeding that did not require medical attention, such as bruising or hemorrhoidal bleeding.

Patients were seen at approximately six-month intervals for a median of 1.5 years following enrollment. Changes in anticoagulant treatment satisfaction after nuisance bleeding were examined descriptively in a subset of patients. Results were published April 20 by Circulation.

Among the 6,771 patients (18,560 visits), 1,357 (20%) had documented nuisance bleeding, for an incidence rate of 14.8 events per 100 person-years. Almost all patients (96.4%) remained on oral anticoagulation after a nuisance bleeding event. Overall, 287 (4.3%) patients experienced major bleeding and 64 (0.96%) had a stroke/systemic embolism event during follow-up.

Nuisance bleeding was not associated with a significantly increased risk of major bleeding over six months after adjustment for the ATRIA bleeding score (odds ratio [OR], 1.04; 95% CI, 0.68 to 1.60; P=0.86). Nuisance bleeding was also not associated with increased stroke or systemic embolism risk within six months, after adjustment for CHA₂DS2-VASc risk score (OR, 1.24; 95% CI, 0.53 to 2.91; P=0.62).

On the basis of the study results, nuisance bleeding should not lead to changes in anticoagulation strategies in patients treated with oral anticoagulation, the authors wrote.

“Our findings suggest that nuisance bleeding is not associated with increased risk for major bleeding among patients prescribed guideline recommended OAC [oral anticoagulation] treatment,” the authors concluded. “However, clinicians should remain vigilant in re-evaluating and controlling modifiable major bleeding risk factors in patients who experience nuisance bleeding.”