Mitral Regurgitation and Body Mass Index Increase the Predictability of Perioperative Bleeding in Anticoagulated Patients With Nonvalvular Atrial Fibrillation

Hao Huang; Chi Cai; Wei Hua; Nixiao Zhang; Hongxia Niu; Xuhua Chen; Jing Wang; Yuhe Jia; Jianmin Chu; Min Tang; Shu Zhang

doi:10.3389/fcvm.2022.846590

Mitral Regurgitation and Body Mass Index Increase the Predictability of Perioperative Bleeding in Anticoagulated Patients With Nonvalvular Atrial Fibrillation

Front Cardiovasc Med. 2022 Mar 28:9:846590. doi: 10.3389/fcvm.2022.846590. eCollection 2022.

Authors

Hao Huang¹, Chi Cai¹, Wei Hua¹, Nixiao Zhang^{1

2}, Hongxia Niu¹, Xuhua Chen¹, Jing Wang¹, Yuhe Jia¹, Jianmin Chu¹, Min Tang¹, Shu Zhang¹

Affiliations

¹ State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
² Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.

Abstract

Background: Catheter ablation (CA) effectively restores sinus rhythm in atrial fibrillation (AF) but causes a short-term fluctuation in the coagulation state. Potential risk factors and better management during this perioperative period remain understudied.

Methods: We consecutively included 940 patients with nonvalvular AF who received CA at Fuwai Hospital, Beijing, China. Patients were divided into two groups according to their bleeding status during 3 months' anticoagulation. Any adverse events related to bleeding in the 3 months were evaluated. The HAS-BLED score and ABC-bleeding score, as well as other potential factors, were explored to predict bleeding risk.

Results: In this observational study, 8.0% and 0.9% of the whole population suffered from bleeding and thromboembolic events, respectively. After adjusting for known factors related to bleeding, mitral regurgitation (MR, p for trend <0.001) and body mass index (BMI, odds ratio (OR) = 0.920, 95% CI 0.852-0.993, p = 0.033) were the most significant ones. C-indexes of the HAS-BLED score and ABC-bleeding score for bleeding were 0.558 (0.492-0.624) and 0.585 (0.515-0.655), respectively. The incorporation of MR and BMI significantly improved the predictive value based on HAS-BLED score (C-index = 0.650, 95% CI 0.585-0.715, p = 0.004) and ABC-bleeding score (C-index = 0.671, 95% CI 0.611-0.731, p < 0.001). The relative risk of mild-moderate MR was 4.500 (95% CI 1.625-12.460) in patients with AF having HAS-BLED = 1 and 4.654 (95% CI 1.496-14.475) in HAS-BLED ≥ 2, while it was not observed in patients with HAS-BLED = 0 (p = 0.722).

Conclusion: More severe MR and lower BMI are associated with a higher incidence of perioperative bleeding, which helps improve the predictability of increased individual bleeding risk of a patient with nonvalvular AF who has received CA therapy and oral anticoagulants.

Keywords: ABC bleeding score; HAS-BLED score; atrial fibrillation; bleeding risk assessment; body mass index; mitral regurgitation.