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Objectives: To estimate the incidence of hemorrhagic events in patients with atrial fibrillation (AF) treated with acenocoumarol and the management cost of those requiring hospitalization, in Greece.

Methods: A telephone survey was conducted between December 2017 and January 2018 using a stratified random sampling procedure to identify cardiologists from all over Greece who treat AF patients with acenocoumarol. 300 cardiologists treating at least 10 AF patients with acenocoumarol during the past 12 months were selected. Data were collected using a structured questionnaire. Cardiologists were asked to report the number of AF patients treated with acenocoumarol during the past 12 months and the number of those who experienced a hemorrhagic event. Moreover, the hospital charges to sickness fund along with the cost of resource utilization during short-term follow-up of all AF patients hospitalized between January 2013 and June 2017 at a tertiary at Hospital in Athens due to bleeding related to acenocoumarol were retrieved from the hospital electronic database.

Results: Out of 48,255 AF patients treated by the 300 participating cardiologists, 12,633 (26.2%) were treated with acenocoumarol during the past 12 months. A total of 5.1% of patients experienced a hemorrhagic event with the incidence of bleeding requiring hospitalization being 1.7%. The most common bleeding site was the gastrointestinal system (51.5%), followed by respiratory tract (19.6%). The mean (95% CI) cost per bleeding event related to acenocoumarol and requiring hospitalization was estimated at €1,202 (€1,058–€1,420), with the total annual national economic burden of these bleedings to be estimated at €1,463,955.

Conclusions: The incidence of bleeding events in AF patients treated with acenocoumarol in Greece, as well as, the estimated annual economic burden of bleedings requiring hospitalization, emphasize the need to comply with the current guidelines for the management of AF side-effects with oral anticoagulants, especially in patients with high bleeding risk.