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The following is a summary of “Thrombocytopenia as a Bleeding Risk Factor in Atrial Fibrillation and Coronary Artery Disease: Insights From the AFIRE Study,” published in the October 2023 issue of Cardiology by Lijima et al.
In patients dealing with atrial fibrillation and chronic coronary syndrome, the presence of thrombocytopenia represents a significant risk factor for heightened susceptibility to major bleeding. This study, conducted using the AFIRE (Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease) trial data, aimed to explore the association between thrombocytopenia, defined as a platelet count below <100 000/mm3, and the incidence of bleeding events.
Among the 2,133 patients assessed in this study, 70 patients belonged to the thrombocytopenia group, while 2063 were in the nonthrombocytopenia group. Findings revealed a notably higher occurrence of major bleeding in the thrombocytopenia group compared to the nonthrombocytopenia group (10.0% versus 4.1%, P=0.027). Furthermore, although not statistically significant, the thrombocytopenia group showed a tendency toward a heightened risk of major adverse cardiovascular ischemic events (11.4% versus 6.2%, P=0.08). Of note, patients with thrombocytopenia receiving a combination therapy involving rivaroxaban and a single antiplatelet drug had a substantially increased risk of bleeding (14.3% versus 5.0%; hazard ratio, 3.18 [95% CI, 1.27–7.97], P=0.014). Thrombocytopenia, as an independent predictor, was significantly associated with a higher likelihood of major bleeding (hazard ratio, 2.57 [95% CI, 1.19–5.56], P=0.017). These results emphasize the necessity for a cautious approach in selecting appropriate drug therapies for patients with thrombocytopenia requiring ongoing antithrombotic treatments.
Source: ahajournals.org/doi/10.1161/JAHA.123.031096
