Observational studyEuropean heart journal. Cardiovascular pharmacotherapy2025
Albumin level and risk of major bleeding in patients with atrial fibrillation on direct oral anticoagulants.
Observational study in European heart journal. Cardiovascular pharmacotherapy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Phenotypic clustering of atrial fibrillation patients using latent class analysis and its potential utility for ablation strategy: insights from the DIRECT-Extend and EARNEST-PVI studies.European heart journal open · 2026Article
- When Atrial Fibrillation Meets Alcoholic Liver Cirrhosis: Can Direct Oral Anticoagulants Bridge the Therapeutic Gap?Biomedicines · 2026Review
- Factor XIII and cardiovascular disease: biomarker, culprit or victim in acute myocardial infarction outcomes?International journal of cardiology. Heart & vasculature · 2025Article
- Our knowledge about atrial fibrillation steadily increases.European heart journal. Cardiovascular pharmacotherapy · 2025Article
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Authors and funding
15 authors.
Funding
Abstract
aimsThe pharmacological effect of direct oral anticoagulants (DOACs) is influenced by binding status with albumin. This study aimed to assess the association between albumin levels and bleeding risk in atrial fibrillation (AF) patients treated with DOACs. METHODS AND
resultsWe conducted DIRECT-Extend registry (N = 7512), a pooled database combining three large-scale observational study of AF patients treated with DOAC. The primary endpoint was major bleeding as defined by International Society on Thrombosis and Haemostasis criteria. Multivariable Cox hazard model was used to assess the impact of albumin level on major bleeding. Out of the overall cohort, 2523 patients [73 (IQR 66-80) years, 1620 (64.2%) males] with albumin data available at enrolment were analyzed in this study. Median follow-up duration was 532 days (IQR 94-1405 days). The entire cohort was divided into tertiles based on albumin levels (lower tertile: <3.7 g/dL, middle tertile: 3.7-4.1 g/dL, and higher tertile: ≥4.1 g/dL). The incidences of major bleeding increased as albumin levels decreased; 56 patients (6.8%), 81 patients (9.7%), and 113 patients (13.1%) in the higher, middle, and lower tertiles, respectively. (Log-rank test P < 0.0001). A lower albumin level was independently associated with a higher incidence of major bleeding (adjusted hazard ratio 0.61, 95% confidence interval 0.47-0.80, P < 0.01), which was consistently observed in all DOACs (P-value for interaction >0.05).
conclusionA lower albumin level was independently associated with a higher bleeding risk in AF patients using DOACs. Careful attention should be paid to hypoalbuminemia when prescribing DOACs.
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