Prediction of bleeding risks in patients with atrial fibrillation on anticoagulation

Atrial fibrillation (AF), the commonest arrhythmia affecting the elderly population worldwide is associated with greater thromboembolic risk and soaring economic burden due to growing aging population. Oral anticoagulation remains the mainstay therapy to minimize risks of ischaemic stroke which has to be balanced against bleeding risks. The aim of the thesis was to establish clinical risk factors and biomarkers which predict good anticoagulation control and major bleeding among patients with AF in a multiethnic population in West Birmingham. This study was conducted prior to approval of NOAC use in AF patients. A registry established discovered being on oral anticoagulant (with VKA therapy), poor anticoagulation control (TTR <70%), increasing stroke risks and age are significant risks factors which predict major bleeding among AF patients. There was no significant clinical risk factor predictive of good anticoagulation control, TTR ≥65% and ≥70%. A separate biomarker study utilising D-Dimer, thrombomodulin, vWf and PAI-1 showed the biomarkers were not significant predictors of major bleeding or good anticoagulation control among AF patients who were anticoagulated. However, TTR