nemia is associated with bleeding and mortality but not stroke in patients with atrial fibrillation insights from the apixaban for reduction in stroke and other thromboembolic events in atrial fibrillation aristotle

Ờ Å ỊÙ× Ư Ờ Anemia Is Associated With Bleeding and Mortality, but Not Stroke, in Patients With Atrial Fibrillation: Insights From the ARISTOTLE Trial B Daan Westenbrink, Marco Alings, Christopher B Granger, John H Alexander, Renato D Lopes, Elaine M Hylek, Laine Thomas, Daniel M Wojdyla, Michael Hanna, Matyas Keltai, P Gabriel Steg, Raffaele De Caterina, Lars Wallentin, Wiek H van Gilst PII: DOI: Reference: S0002-8703(16)30289-7 doi: 10.1016/j.ahj.2016.12.008 YMHJ 5342 To appear in: American Heart Journal Received date: Accepted date: 28 September 2016 16 December 2016 Please cite this article as: Westenbrink B Daan, Alings Marco, Granger Christopher B., Alexander John H., Lopes Renato D., Hylek Elaine M., Thomas Laine, Wojdyla Daniel M., Hanna Michael, Keltai Matyas, Gabriel Steg P, De Caterina Raffaele, Wallentin Lars, van Gilst Wiek H., Anemia Is Associated With Bleeding and Mortality, but Not Stroke, in Patients With Atrial Fibrillation: Insights From the ARISTOTLE Trial, American Heart Journal (2016), doi: 10.1016/j.ahj.2016.12.008 This is a PDF file of an unedited manuscript that has been accepted for publication As a service to our customers we are providing this early version of the manuscript The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain ACCEPTED MANUSCRIPT Anemia Is Associated With Bleeding and Mortality, but Not Stroke, in Patients With Atrial Fibrillation: Insights From the ARISTOTLE Trial RI PT RCT# NCT00412984 B Daan Westenbrink, MD, PhD,1 Marco Alings, MD, PhD,2 Christopher B Granger, MD,3 John H SC Alexander, MD,3 Renato D Lopes, MD, PhD,3 Elaine M Hylek, MD, MPH,4 Laine Thomas, PhD,3 NU Daniel M Wojdyla,3 Michael Hanna, MD,5 Matyas Keltai, MD, PhD, DSc,6 P Gabriel Steg, MD,7 MA Raffaele De Caterina, MD, PhD,8 Lars Wallentin, MD,9 Wiek H van Gilst, PhD1 University Medical Center Groningen, University of Groningen, Groningen, Netherlands; 2Working D Group on Cardiovascular Research, Utrecht, Netherlands; 3Duke Clinical Research Institute, Duke TE University School of Medicine, Durham, NC; 4Boston University School of Medicine, Boston, MA; Bristol-Myers Squibb, Princeton, NJ; 6Hungarian Institute of Cardiology, Budapest, Hungary; 7DHU AC CE P FIRE, Université Paris-Diderot, Hôpital Bichat, AP-HP, INSERM U-1148, Paris, France; 8G d’Annunzio Univ and Fondazione Toscana G Monasterio, Chieti, Italy; 9Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden Short title: Anemia and bleeding propensity Article type: Clinical Investigation Address for correspondence: Dr B.D Westenbrink, Department of Cardiology, University Medical Center Groningen, Hanzeplein 1, P.O Box 30001, 9700 RB Groningen, The Netherlands Tel.: (+31) 503616161 / Fax: (+31) 503614391 E-mail: b.d.westenbrink@umcg.nl ACCEPTED MANUSCRIPT Background: Patients with atrial fibrillation (AF) are prone to cardiovascular events and anticoagulationrelated bleeding complications We hypothesized that patients with anemia are at increased risk for these PT outcomes Methods: We performed a post-hoc analysis of the Apixaban for Reduction in Stroke and Other RI Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial, which included over 18,000 patients SC with AF randomized to warfarin (target INR 2.0–3.0) or apixaban mg twice daily Multivariable Cox regression analysis was used to determine if anemia (defined as hemoglobin [Hb]