title: Anticoagulation use and predictors of stroke, bleeding and mortality in multi-ethnic Asian patients with atrial fibrillation: A single centre experience.
abstract: Atrial fibrillation (AF) is the most common cardiac arrhythmia in singapore. We describe a cohort of multi-ethnic Asian patients with AF, with the aim to evaluate anticoagulation use and to identify factors predictive of stroke, bleeding and all-cause mortality.
  
  
  
  this was a single centre, retrospective cohort study. All patients with an admission diagnosis of AF between 1 January 2000 and 31 December 2010 were identified. Of these patients, those who had follow-up data up to 31 December 2012 were included in the study.
  
  
  
  there were 1095 eligible patients. the mean age was 67±14 years, mean cHADs2 score was 2±1 and mean HAs-bLED score 2±1. Of the 1095 patients, 657 (62.0%) had a cHADs2 score ≥ 2 but only 215 (32.7%) were eventually prescribed warfarin. Patients not on warfarin were older (p<0.0001) and were more likely females (p<0.0001). Among patients not on warfarin, 52% had HAs-bLED score ≤3. Multivariate analysis revealed that warfarin use and high HAs-bLED score were associated with increased bleeding risk. Age, Indian ethnicity and cHADs2 score were predictive of ischemic stroke. All-cause mortality was significantly related to age, presence of heart failure and HAs-bLED score.
  
  
  
  Anticoagulation management of AF patients remains inadequate. Objective assessment of bleeding risks should be performed before withholding anticoagulation.
authors.affiliation: Tan Tock Seng Hospital, Department of Cardiology, 11 Jalan Tan Tock Seng, Singapore 308433. powlichia@gmail.com.
authors.forename: P L
authors.initials: PL
authors.lastname: Chia
authors.affiliation: Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.
authors.forename: X
authors.initials: X
authors.lastname: Teoh
authors.affiliation: Singapore Health Services.
authors.forename: C M
authors.initials: CM
authors.lastname: Hua
authors.affiliation: Tan Tock Seng Hospital, Department of Cardiology, 11 Jalan Tan Tock Seng, Singapore 308433.
authors.forename: M E
authors.initials: ME
authors.lastname: Ching
authors.affiliation: Tan Tock Seng Hospital, Department of Cardiology, 11 Jalan Tan Tock Seng, Singapore 308433.
authors.forename: D
authors.initials: D
authors.lastname: Foo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000401:mortality*; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin