부산대학교 도서관

Background: Anemia frequently co-exists with atrial fibrillation (AF). We performed a systematic review and meta-analyses to comprehensively assess the effect of anemia on stroke/systemic thromboembolism, bleeding, and mortality in patients with AF.Methods: MEDLINE and Embase were searched until May 2020. Cohort studies and secondary analyses of randomised controlled trials examining the association of anemia with the above outcomes in AF were included and random-effects meta-analyses of reported hazard ratios were undertaken.Results: Twenty-eight studies involving 365,484 patients with mean follow-up of 2.0 years were included. Of the studies that provided the relevant information, 41% of patients were female, mean age was 74.7 years, 76% were on oral anticoagulation, and prevalence of anemia was 16%. Anemia was associated with a 78% increase in all-cause mortality (HR 1.78, 95% CI 1.44-2.20), a 15% increase in stroke/systemic thromboembolism (HR 1.15, 95% CI 1.01-1.31), and a 78% increase in major bleeding (HR 1.78, 95% CI 1.54-2.05). Including studies that reported odds ratios and excluding conference abstracts did not discernibly alter the results. Between-study heterogeneity was substantial in the majority of meta-analyses performed. Additional meta-analyses for cardiovascular/non-cardiovascular mortality and gastrointestinal bleeding as outcomes, and using hemoglobin as a continuous predictor, yielded similar results.Conclusion: Anemia is common in patients with AF and is associated with an increased risk of stroke/systemic thromboembolism, major bleeding, and all-cause mortality. Future studies are required to explore the causes of anemia in AF, and whether further investigation and treatment may be clinically beneficial in affected individuals.