Correlation between anticoagulant therapy strategy and bleeding risk in patients with atrial fibrillation based on MIMIC-ED database

Background: Current bleeding risk scores lack precision in elderly and comorbid populations. This study addresses this gap by developing a model tailored to atrial fibrillation (AF) patients undergoing diverse anticoagulation therapies. Methods: Clinical data of 6968 AF patients who underwent prophylactic early anticoagulation therapy were screened and gathered from the Medical Information Mart for Intensive Care-Emergency Department (MIMIC-ED) database. Patients were divided into a bleeding group (n = 280) and a non-bleeding group (n = 6688) based on the occurrence of bleeding. The bleeding risks related to diverse anticoagulant therapy approaches among AF patients were contrasted, and the clinical data of the two groups were compared. Significant differences in clinical data between the two groups were selected to establish a predictive model for post-anticoagulation bleeding in AF patients. Results: Bleeding occurred in 4.02% of patients. Apixaban had the lowest bleeding rate (2.94%), while Warfarin (4.42%) and Enoxaparin (5.22%) showed higher risks. Independent predictors included gender, age, dementia, malignancy, liver disease, metastatic tumors, Warfarin use and platelet count. The predictive model achieved an Area Under the Curve (AUC) of 0.726 (95% Confidence Interval (CI): 0.693–0.760) with 53.9% sensitivity and 82.4% specificity. Conclusions: The risk of bleeding after anticoagulation therapy in AF patients is influenced by multiple factors, including basic demographic characteristics (gender, age), comorbid chronic conditions (dementia, malignant cancer, severe liver disease, and metastatic solid tumors), medication use (Warfarin) and laboratory indicators (Platelet Count). The bleeding risk predictive model established in this study shows excellent diagnostic performance and capable of offering significant decision support for individualized management of anticoagulation therapy.

MIMIC-ED database; Atrial fibrillation; Anticoagulation therapy; Bleeding risk

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