Atrial fibrillation (AF) and thrombocytopenia present a complex clinical challenge when occurring concurrently. This combination raises important considerations for patient management, particularly regarding anticoagulation strategies and bleeding risks. AF is the most common sustained cardiac arrhythmia, characterized by irregular and often rapid heart rate due to disorganized electrical signals in the atria.1 It significantly increases the risk of stroke and systemic embolism, necessitating anticoagulation therapy in many patients. The decision to anticoagulate is typically based on stroke risk factors, often assessed using the CHA₂DS₂-VASc score.2

Thrombocytopenia, defined as a platelet count below 150 × 109/L, is a relatively common condition in patients with AF.3 It can occur due to various reasons, including hematological disorders, liver disease, chronic kidney disease, and as a side effect of certain medications.4 The presence of thrombocytopenia complicates the management of AF patients, as it potentially increases the risk of bleeding, a major concern when considering anticoagulation therapy.5 Studies have shown that thrombocytopenia is associated with increased mortality in AF patients.6 However, the relationship between thrombocytopenia and clinical outcomes in anticoagulated AF patients is complex. While thrombocytopenia may increase bleeding risk, it has also been associated with a lower risk of stroke in some studies.7

The management of AF patients with thrombocytopenia requires careful consideration of the balance between thromboembolic and bleeding risks. Traditional anticoagulants like warfarin and newer non-vitamin K antagonist oral anticoagulants (NOACs) are options, but their use must be carefully evaluated in the context of thrombocytopenia. Some studies suggest that NOACs may be a reasonable choice for stroke prevention in AF patients with thrombocytopenia.8 Alternative strategies, such as left atrial appendage occlusion, have also been explored for AF patients with contraindications to long-term oral anticoagulation, including those with severe thrombocytopenia.9

Given the scarcity of large-scale data on the clinical outcomes and trends in AF patients with thrombocytopenia, this study aims to evaluate the outcomes of this population using the National Inpatient Sample (NIS) database. We seek to provide insights into the trends and outcomes of patients with concurrent AF and thrombocytopenia, particularly regarding mortality, bleeding risk, and resource utilization.

This analysis offers a unique opportunity to better understand the risks associated with this dual condition, with the ultimate goal of informing clinical decision-making and improving patient care in this challenging patient population.