Takeaway
- This meta-analysis suggests that restarting oral anticoagulant (OAC) therapy after a major bleeding event in Afib is associated with positive clinical benefit when compared to non-restarting OAC.
- Significant reduction in any thromboembolism and all-cause mortality was observed in patients with Afib who restarted OAC.
Why this matters
- Decision to restart OAC after a major bleeding episode still remains a highly debated topic.
- European Society of Cardiology (ESC) Afib guidelines in the 2016 and a recent position paper from ESC working group on thrombosis recommend restart of OAC after a major bleeding.
Study design
- Systematic review and meta-analysis of 7 studies consisting of 5685 patients with Afib who experienced major bleeding.
- Funding: None disclosed.
Key results
- Net clinical benefit (NCB) analysis showed a clinically significant advantage in restarting OAC therapy after a major bleeding (NCB, 0.11; 95% CI, 0.09-0.14; P<.001).
- A 10.8% absolute risk reduction was seen among OAC restarters for all-cause death (OR, 0.38; 95% CI, 0.24-0.60; P<.00001).
- No difference in the risk for any stroke occurrence was seen between OAC restarters and non-restarters (OR, 0.75; 95% CI, 0.37-1.51), and a 45% increase in risk was seen in patients with any major bleeding (P=.02).
- Increased risk for major bleeding was observed in OAC restarters (OR, 1.85; 95% CI, 1.48-2.30).
Limitations
- Risk for bias.
References
References
