title: The safety and efficacy of vitamin K antagonist in atrial fibrillation patients with previous ulcer bleeding: Long-term results from a multicenter study.
abstract: This study aimed to evaluate the safety and efficacy of vitamin K antagonist (VKA) in atrial fibrillation (AF) patients with previous ulcer bleeding.In this multicenter, retrospective analysis, clinical outcomes of 754 AF patients with a history of ulcer bleeding were evaluated. After ulcer treatment, 458 patients (61%) were treated with VKA, and the outcomes were compared to 296 patients (39%) without VKA.VKA treatment significantly increased major bleeding (7.3%/year vs 3.2%/year, P < 0.001), and reduced major adverse cardiac events (MACE) (5.4%/year vs 10.0%/year, P < 0.001). Specifically, risk of gastrointestinal bleeding was significantly higher in the VKA group than no-VKA group (5.7%/year vs 2.6%/year, P < 0.001). Consequently, there was no difference in the incidence of composite of a MACE and major bleeding, between the 2 groups. In patients with time in the therapeutic range (TTR) ≥65%, VKA significantly decreased MACE (2.8%/year vs 10.0%/year, P < 0.001) without increasing major bleeding. Net clinical benefit model showed beneficial effects of VKA in patients with TTR ≥65%, and harmful effects in those with TTR < 55%.In AF patients with previous ulcer bleeding, VKA treatment did not improve clinical outcomes unless the international normalized ratio level was constantly maintained (TTR ≥65%), as the gastrointestinal bleeding (GIB) risk significantly increased.
authors.affiliation: Division of Cardiology, Yonsei University College of Medicine, Seoul Division of Cardiology, Bundang CHA Medical Center, CHA University, Seongnam Division of Cardiology, Kyung Hee University College of Medicine, Seoul Division of Cardiology, Yonsei University Wonju College of Medicine, Wonju Division of Cardiology, Sanggye Paik Hospital, Inje University College of Medicine Division of Cardiology, Gangnam Severance Hospital, Seoul, Republic of Korea.
authors.forename: Seung-Jun
authors.initials: SJ
authors.lastname: Lee
authors.forename: Jung-Hoon
authors.initials: JH
authors.lastname: Sung
authors.forename: Jin-Bae
authors.initials: JB
authors.lastname: Kim
authors.forename: Min-Soo
authors.initials: MS
authors.lastname: Ahn
authors.forename: Hye Young
authors.initials: HY
authors.lastname: Lee
authors.forename: Jae-Sun
authors.initials: JS
authors.lastname: Uhm
authors.forename: Hui-Nam
authors.initials: HN
authors.lastname: Pak
authors.forename: Moon-Hyoung
authors.initials: MH
authors.lastname: Lee
authors.forename: Jong-Yun
authors.initials: JY
authors.lastname: Kim
authors.forename: Boyoung
authors.initials: B
authors.lastname: Joung
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000139:chemically induced*; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D014812:Vitamin K