1, 9 There is, however, limited information comparing these commonly used bleeding scales in a single at-risk cohort of patients with atrial fibrillation (AF).
Several scales for the classification of bleeding events are in widespread use in clinical trials and registries, including the ISTH (International Society on Thrombosis and Haemostasis), 5 TIMI (Thrombolysis in Myocardial Infarction), 6, 7 GUSTO (Global Use of Strategies to Open Occluded Arteries), 8 and BARC (Bleeding Academic Research Consortium) scales ( Table 1). Therefore, accurate characterization of bleeding events is critical for the evaluation and ongoing monitoring of cardiovascular therapies. Bleeding leads to direct patient harm and the cessation of cardiovascular medications, which may result in an increased risk of ischemic events. The direction of this trend was consistent for both gastrointestinal bleeding and nongastrointestinal bleeding.īleeding is an important complication of numerous cardiovascular therapies, including anticoagulants, antiplatelet agents, fibrinolytics, and invasive procedures. Furthermore, a gradient of more pronounced risk reduction with edoxaban was observed with greater severity of first bleeding event (higher-dose edoxaban regimen: HR, 0.47 for BARC 3c+5 bleeds versus HR, 0.86 for any BARC bleed lower-dose edoxaban regimen: HR, 0.32 for BARC 3c+5 bleeds versus HR, 0.68 for any BARC bleed). Lower bleeding risk with edoxaban compared with warfarin was seen regardless of bleeding scale (higher-dose edoxaban regimen range: hazard ratio, 0.47 for BARC 3c+5 versus HR, 0.80 for ISTH major lower-dose edoxaban regimen range: HR, 0.32 for BARC 3c+5 versus HR, 0.47 for ISTH major). In a comparison of the most severe events in each scale, ISTH major bleeding was the most common (n=1289), followed by TIMI major (n=548), GUSTO severe/life-threatening (n=347), and BARC 3c+5 (n=276) bleeding. Customer Service and Ordering InformationĪ total of 10 311 bleeding events were reported.Stroke: Vascular and Interventional Neurology.Journal of the American Heart Association (JAHA).Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB).Moreover, LA dysfunction was present despite normal LA size and sinus rhythm, suggesting that the assessment of LA function may add important incremental information in the evaluation of AF patients. CONCLUSIONS: In a contemporary AF population, LA structure and function were increasingly abnormal with a greater electrical burden of AF and higher stroke risk estimated by the CHADS2 score.
Moreover, 19% of AF subjects had impaired LAEF despite normal LA size, and LA contractile dysfunction was present even among the subset of AF subjects in sinus rhythm at the time of echocardiography. With an increasing electrical burden of AF and higher CHADS2 scores, LA size increased and LAEF declined. The majority of AF patients (55%) had both LA enlargement and reduced LAEF, with an inverse relationship between LA size and LAEF (R = -0.57, P < 0.001). Left atrial size, emptying fraction (LAEF), and contractile function were compared across AF types (paroxysmal, persistent, or permanent) and CHADS2 scores as an estimate of stroke risk. METHODS AND RESULTS: Left atrial structure and function was assessed in 971 subjects enrolled in the echocardiographic substudy of ENGAGE AF-TIMI 48. We aimed to describe LA structure and function in AF. Abstract International audienceAIMS: The complex relationship between left atrial (LA) structure and function, electrical burden of atrial fibrillation (AF) and stroke risk is not well understood.
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