National trends, outcomes and readmissions secondary to major bleeding in patients with intracardiac thrombus

Author(s): Tanveer Mir, Waqas T Qureshi, Mohammad Uddin, Tanveer Hussain, Jawarya Safdar, Waseem Amjad, Javed Iqbal Wani, Mujeeb Sheikh

Background: Bleeding risk in intracardiac thrombus has not been examined previously.

Aim: To evaluate the predictors and bleeding outcome of patients with intracardiac thrombus.

Methods: A national representative cohort of 214,476 intracardiac thrombus patients were included for the years 2010–2017 from the national readmission database. We examined predictors and trends of major bleeding in patients that were diagnosed with intracardiac thrombus. We examined the association of major bleeding with mortality and readmission. We also evaluated the association of HAS-BLED score with readmission.

Results: Out of 214,476 patients with intracardiac thrombus, 38,545 (18%) suffered from major bleeding patients during the index hospitalization. Of the total 204,432 discharged alive within the first 11 months of the year, 4079 (2.0%) had readmissions due to major bleeding. During index hospitalization, the commonest form of major bleeding was gastrointestinal 10808 (28%). Higher mortality rates were observed in the major bleeding group (9.2% vs. 3.7%) with increasing trends over the years 2010– 2017 (p trend=0.03). Major bleeding was associated with increased risk of mortality (OR: 2.40; 95% CI: 2.20–2.62, p<0.001). Among predictors for major bleeding, malignancy (OR 1.49, p<0.001), atrial fibrillation (OR: 1.14, p<0.001), peripheral arterial disease (OR: 1.27, p<0.001) were the predominant ones. The predictors of readmission with major bleeding included female sex (HR: 1.26, p<0.001), malignancy (HR 2.13, p<0.001), peripheral vascular disease (HR 1.37, p<0.001), chronic heart failure (HR: 1.81, p<0.001) and HAS-BLED score (HR: 1.23, p<0.001). HAS-BLED score improved the predictability of readmission significantly over and above the conventional bleeding risk factors (p=0.004).

Conclusion: Major bleeding is common in patients with intracardiac thrombus. Malignancy was one of the predominant risk factors for major bleeding. HAS-BLED even though was associated with major bleeding readmission however was found to have mild improvement in prediction in addition to other risk factors. Up-trending mortality was observed in major bleeding patients which suggests more research for better risk scales.