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CC BY 4.0 · Thromb Haemost
DOI: 10.1055/a-2690-1674
Stroke, Systemic or Venous Thromboembolism

Racial Differences in Bleeding Risks among Patients with Atrial Fibrillation: An Ecological Epidemiological Study Comparing Korea and UK Population

Dong-Seon Kang‡   *
1   Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
2   Division of Cardiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Gyeonggi-do, Republic of Korea
,
Pil-Sung Yang‡   *
1   Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
,
Daehoon Kim
1   Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
,
Eunsun Jang
1   Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
,
Hee Tae Yu
1   Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
,
Tae-Hoon Kim
1   Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
,
Jung Hoon Sung
3   Division of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
,
Hui-Nam Pak
1   Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
,
Gregory Y.H. Lip    **
4   Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
5   Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
,
Boyoung Joung   **
1   Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
› Author Affiliations
Funding This research was supported by a grant of Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea (RS-2024-00397290).
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Abstract

Background

Racial differences in the propensity to bleeding may be evident, with a higher risk of bleeding in Asian populations. This study aimed to assess racial differences in bleeding risk among patients with atrial fibrillation (AF) using an ecological epidemiological approach.

Methods

We included patients with AF from the Korean National Health Insurance Service-Health Screening and UK Biobank who underwent health check-ups between 2006 and 2010. The analysis involved 1928 East Asians (62.1% male, median age 60.0 years) and 5917 White Europeans (71.4% male, median age 64.0 years) were analyzed. Primary outcome was composed of intracranial hemorrhage and bleeding from the gastrointestinal, respiratory, and genitourinary systems.

Results

During follow-up, the primary outcome occurred in 126 East Asians and 587 White Europeans. East Asians had a 42% lower 5-year incidence rate compared with White Europeans (weighted incidence rate 1.31 vs. 2.24 per 100 person-years; incidence rate ratio 0.58, 95% confidence interval: 0.41–0.83). Contrary to the primary outcome, the incidence of intracranial hemorrhage tended to be higher among East Asians (weighted incidence rate 0.34 vs. 0.14 per 100 person-years; incidence rate ratio 2.36, 95% confidence interval: 0.88–6.37). These results persisted even in patients naïve to antithrombotic drugs. East Asians who were already taking antithrombotic drugs at baseline showed no significant difference in the incidence of the primary outcome compared with White Europeans.

Conclusion

This ecological study highlights racial differences in the incidence of bleeding influenced by anatomical site and antithrombotic drug use and underscores the necessity for race-based tailored approaches.

Keywords

racial difference - atrial fibrillation - intracranial hemorrhage - gastrointestinal bleeding

Data Availability Statement

Data from K-NHIS-HealS are available on the Web site (http://nhiss.nhis.or.kr). Data from UK Biobank are available upon application.


Authors' Contribution

D.S.K. and P.S.Y. contributed equally to this work. G.Y.H.L. and B.J. contributed to the conception and design of the work and critical revision of the manuscript. D.S.K. contributed to the conception and design of the work, analysis and interpretation of data, and drafting of the manuscript. P.S.Y., D.K., and E.J. contributed to data extraction and analysis. H.T.Y., T.H.K., J.H.S., and H.N.P. contributed to the conception and design of the work and revision of the manuscript. All authors approved the final version to be published. Also, they are responsible for ensuring that questions relating to accuracy or integrity of all parts of the work are properly investigated and resolved. The corresponding author certifies that all listed authors meet authorship criteria.


* These authors contributed equally to this work.


** These authors are joint senior authors.


The review process for this paper was fully handled by Christian Weber, Editor in Chief.


Supplementary Material



Publication History

Received: 06 May 2025

Accepted: 25 August 2025

Accepted Manuscript online:
26 August 2025

Article published online:
09 September 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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