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Komen JJ, Forslund T, Mantel - Teeuwisse AK, Klungel OH, Wettermark B, Von Euler M, Braunschweig F, Wallen H, Hjemdahl P. 3053High mortality in atrial fibrillation patients suffering ischemic stroke, intracranial hemorrhage or a gastrointestinal bleed and associations with the preceding antithrombotic treatment. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Anticoagulation treatment reduces the risk of stroke but increases the risk of bleeding in atrial fibrillation (AF) patients. There is little data on survival after a stroke or a severe bleed.
Objective
To analyze 90-day mortality in AF patients after an ischemic stroke, an intracranial hemorrhage (ICH) or a gastrointestinal bleed (GIB) and assess associations with the type of antithrombotic treatment preceding the event.
Methods
From the Stockholm Healthcare database (n=2.3 million inhabitants) we selected all AF patients suffering from an ischemic stroke, an intracranial bleed, or a severe GIB requiring acute hospital care between July 2011 and August 2018 and assessed 90-day mortality rates. We assessed current use of warfarin, non-vitamin K oral anticoagulants (NOAC), or antiplatelet agents at the time of the event. We used a Cox regression to calculate adjusted hazard ratios (aHRs), adjusting for components of the Charlson Comorbidity Index, the CHADsVASc score, the HAS-BLED score, comedication, and year of inclusion, for the association between treatment preceding the event and mortality. In addition, we performed log-rank tests in propensity score matched cohorts.
Results
Of 105 313 patients with AF, 6 017 were included after an ischemic stroke, 3 006 after an ICH, and 4 291 after a GIB. 90-day mortality rates were 25.1%, 31.6% and 16.2%, respectively. Patients suffering from an ischemic stroke were the oldest at 81.6±9.8 (S.D:) years of age followed by patients suffering from an ICH (80.2±9.8 years) or a GIB (78.7±10.5 years). A large proportion of patients suffering ischemic stroke (72%) had no anticoagulant treatment preceding the event. After ICH, there was a significantly increased risk of mortality in warfarin compared to NOAC treated patients after adjusting for confounders (aHR: 1.36 CI: 1.04–1.78). Patients receiving antiplatelets or no treatment had significantly higher mortality rates than patients on NOAC treatment, both after an ischemic stroke and a GIB, but there was no significant difference between warfarin and NOACs (aHR 0.84 CI: 0.63–1.12 after ischemic stroke, aHR 0.91 CI: 0.66–1.25 after GIB). Propensity score matched analyses yielded similar results.
Survival curves after event
Conclusion
Mortality rates are high in AF patients suffering from an ischemic stroke, an ICH, or a GIB. NOAC treatment was associated with a lower 90-day mortality after ICH than warfarin, but no such difference was found after ischemic stroke or GIB. After ischemic stroke and GIB, mortality rates were higher in antiplatelet treated and untreated patients compared to NOAC treated patients.
Acknowledgement/Funding
Swedish Heart Lung Foundation
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Affiliation(s)
- J J Komen
- Institute for Pharmaceutical Sciences, Utrecht, Netherlands (The)
| | | | | | - O H Klungel
- Institute for Pharmaceutical Sciences, Utrecht, Netherlands (The)
| | | | | | | | - H Wallen
- Karolinska Institute, Stockholm, Sweden
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Forslund T, Komen JJ, Andersen M, Wettermark B, Von Euler M, Mantel-Teeuwisse AK, Braunschweig F, Hjemdahl P. 1458Improved stroke prevention in atrial fibrillation after the introduction of NOACs; the Stockholm experience. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - J J Komen
- Utrecht University, Pharmaceutical Sciences, Utrecht, Netherlands
| | - M Andersen
- University of Copenhagen, Drug Design and Pharmacology, Copenhagen, Denmark
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Loikas D, Forslund T, Wettermark B, Schenck-Gustafsson K, Hjemdahl P, Von Euler M. P3582Increased thromboprophylactic treatment of patients with atrial fibrillation after the introduction of NOACs - an analysis of sex and gender differences. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Basu B, Gourley C, Gabra H, Vergote I, Brenton J, Abrahmsen L, Smith A, Von Euler M, Green J. PISARRO: A EUTROC phase 1b study of APR-246 with carboplatin (C) and pegylated liposomal doxorubicin (PLD) in relapsed platinum-sensitive high grade serous ovarian cancer (HGSOC). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw368.29] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Forslund T, Wettermark B, Wandell P, Von Euler M, Hasselstrom J, Hjemdahl P. Risk scoring and thromboprophylactic treatment of patients with atrial fibrillation with and without access to primary healthcare data: experience from the Stockholm health care system. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p4100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Von Euler M, Pöllánen P, Söder O, Ritzén E. Mechanisms for testicular relapse of acute lymphoblastic leukemia. J Reprod Immunol 1989. [DOI: 10.1016/0165-0378(89)90342-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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