Ischemic stroke in low risk patients with atrial fibrillation: a nationwide, registry-based cohort study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
Z Mandalenakis ◽  
E Spanos ◽  
T.V.S Sandstrom ◽  
A.R Rosengren ◽  
P.O.H Hansson
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Ischemic Stroke ◽  
Cardiovascular Risk ◽  
Cox Regression ◽  
Age Groups ◽  
Good Evidence ◽  
Aged Patients ◽  
Cardiovascular Comorbidity ◽  
Risk Patients

Abstract Background Despite the good evidence on the prevention of ischemic stroke in high risk patients with atrial fibrillation (AF), the knowledge in AF patients without any cardiovascular risk factors is still limited and the treatment has been highly questioned. Methods We linked data from Swedish health registers to identify all patients with AF but without any previous cardiovascular comorbidity. The risk of ischemic stroke was investigated by using Cox regression models and patients with AF compared with two controls without AF, matched for age and sex. Results Altogether, 229,613 patients with AF and 457,332 matched controls without AF were included in the study; 44.4% of the population were women. Both the 1-year and the 5-year risk to develop ischemic stroke was higher in patients with AF compared to their matched controls without AF, hazard ratio (HR) of 3.7 (95%, confidence interval (CI) 3.5–3.8) and 2.5 (95%, CI 2.5–2.6) respectively. According to the age groups, patients with age of 35 to 49 years had the highest risk to develop ischemic stroke within the first year after AF diagnosis, HR 8.3 (95%, CI 4.0–17.1). Women with AF had 4.4 times higher risk to develop ischemic stroke (HR 4.4, CI 4.2–4.7) compared to matched women without AF. Conclusions In this large, register-based, nationwide cohort study, we found that the 1-risk and 5-year risk to develop ischemic stroke was significantly higher in patients with AF but without any cardiovascular risk factor for stroke, compared to matched controls without AF. Women and middle-aged patients with AF carried the highest risk to develop ischemic stroke indicating the need of further research on risk stratification despite traditional factors. FUNDunding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): The Swedish state and The Swedish Research Council

scholarly journals Edoxaban versus warfarin on stroke risk in patients with atrial fibrillation: a territory-wide cohort study

2021 ◽  
Author(s):  
Dicken Kong ◽  
Jiandong Zhou ◽  
Sharen Lee ◽  
Keith Sai Kit Leung ◽  
Tong Liu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Ischemic Stroke ◽  
Propensity Score ◽  
Ischaemic Stroke ◽  
Propensity Score Matching ◽  
Lower Risk ◽  
Cox Regression ◽  
Significant Risk ◽  
Risk Predictors

AbstractBackgroundIn this territory-wide, observational, propensity score-matched cohort study, we evaluate the development of transient ischaemic attack and ischaemic stroke (TIA/Ischaemic stroke) in patients with AF treated with edoxaban or warfarin.MethodsThis was an observational, territory-wide cohort study of patients between January 1st, 2016 and December 31st, 2019, in Hong Kong. The inclusion were patients with i) atrial fibrillation, and ii) edoxaban or warfarin prescription. 1:2 propensity score matching was performed between edoxaban and warfarin users. Univariate Cox regression identifies significant risk predictors of the primary, secondary and safety outcomes. Hazard ratios (HRs) with corresponding 95% confidence interval [CI] and p values were reported.ResultsThis cohort included 3464 patients (54.18% males, median baseline age: 72 years old, IQR: 63-80, max: 100 years old), 664 (19.17%) with edoxaban use and 2800 (80.83%) with warfarin use. After a median follow-up of 606 days (IQR: 306-1044, max: 1520 days), 91(incidence rate: 2.62%) developed TIA/ischaemic stroke: 1.51% (10/664) in the edoxaban group and 2.89% (81/2800) in the warfarin group. Edoxaban was associated with a lower risk of TIA or ischemic stroke when compared to warfarin.ConclusionsEdoxaban use was associated with a lower risk of TIA or ischemic stroke after propensity score matching for demographics, comorbidities and medication use.

scholarly journals Bleeding and thromboembolism due to drug-drug interactions with non-vitamin K antagonist oral anticoagulants—a Swedish, register-based cohort study in atrial fibrillation outpatients

2020 ◽  
Author(s):  
Johan Holm ◽  
Buster Mannheimer ◽  
Rickard E Malmström ◽  
Erik Eliasson ◽  
Jonatan D Lindh
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Ischemic Stroke ◽  
Vitamin K ◽  
Cox Regression ◽  
Oral Anticoagulants ◽  
Outcome Data ◽  
Vitamin K Antagonist ◽  
Drug Register ◽  
Increased Risk

Abstract Purpose To study the association between interacting drugs and bleeding or thromboembolism in atrial fibrillation outpatients treated with non-vitamin K antagonist oral anticoagulants (NOACs). Methods Population-based cohort study of outpatients treated with NOACs in Sweden from 2008 to 2017. Patients with atrial fibrillation and newly initiated NOAC treatment were identified in the Prescribed Drug Register. Comorbidities and outcome data were retrieved from the Patient Register and the Cause of Death Register. Cox-regression analyses were performed to evaluate the primary endpoints any severe bleed and ischemic stroke/transient ischemic attack/stroke unspecified during the first six months of treatment. Secondary endpoints were gastrointestinal bleeding, intracranial bleeding, ischemic stroke, and venous thromboembolism. Results Increased risk of any severe bleed was found when NOAC treatment, and drugs with pharmacodynamic effect on bleeding were combined, compared to NOAC only. An increased risk with these combinations was evident for apixaban (hazard ratio (HR) 1.47; 95% CI 1.33–1.63), rivaroxaban (HR 1.7; 95% CI 1.49–1.92), and dabigatran (HR 1.26; 95% CI 1.05–1.52). For apixaban, there was an increased risk of any severe bleed when combined with CYP3A4 and/or P-glycoprotein (P-gp) inhibitors (HR 1.23; 95% CI 1.01–1.5). The use of inducers of CYP3A4 and/or P-gp was low in this cohort, and effects on ischemic stroke/TIA/stroke unspecified could not be established. Conclusion Increased risk of bleeding was seen for pharmacodynamic and pharmacokinetic interactions with NOACs. Prescribers need to be vigilant of the effect of interacting drugs on the risk profile of patients treated with NOACs.

scholarly journals Association between body mass index and the risk of atrial fibrillation and ischemic stroke according to age: a nationwide population-based cohort study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
H J Ahn ◽  
S R Lee ◽  
E K Choi ◽  
K D Han ◽  
S I Kwon ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Body Mass Index ◽  
Cohort Study ◽  
Ischemic Stroke ◽  
Body Mass ◽  
Age Groups ◽  
The Elderly ◽  
Population Based ◽  
Age Group ◽  
Increased Risk

Abstract Background Atrial fibrillation (AF) and ischemic stroke (IS) are two significant cardiovascular diseases that confer an enormous healthcare burden. A limited study comprehensively evaluated the association between full ranges of body mass index (BMI), including underweight, and AF or IS risks, especially in the different age subgroups. Purpose We investigated the association between BMI and AF and IS incidence according to the Korean population's age groups. Methods This was a nationwide population-based cohort study using data from the Korea National Health Insurance Service, including 9 194 477 healthy adults who underwent a medical examination in 2009. We stratified the study population into three age subgroups: age 20–39 (young, 33.1%), age 40–64 (middle-aged, 56.3%), and age over 65 years (elderly, 10.6%). In each age group, the individuals were categorized based on BMI (kg/m2) into underweight (<18.5), normal (18.5 to <23), overweight (23 to <25), obese I (25 to <30), and obese II (≥30). The first occurrences of AF and IS were followed up until December 31, 2018. According to BMI in each age group, the risks of AF and IS were analyzed by Cox proportional hazards regression with 95% confidence intervals (CI) by adjusting age, sex, lifestyle behaviors, and comorbidities. Results Overall, both underweight and higher BMI were associated with an increased risk of AF and stroke across all age groups. The increased risk of AF for patients with obese II was slightly accentuated compared to patients with normal BMI in the young population than elderly population (hazard ratio [HR] 1.78, 95% CI 1.63–1.94 for age 20–39 years; HR 1.55, 95% CI 1.48–1.61 for age ≥65 years, respectively). For underweight individuals, however, the increased risk of AF became more prominent in the elderly: HR and 95% CI was 1.12 (1.07–1.17) in the age over 65 years old, and 1.05 (0.94–1.16) in the age 20–39. Regarding IS, the young group presented a considerable increment in the magnitude of HRs in both underweight and higher BMI groups. However, the association between the BMI and stroke risk became attenuated in the elderly: HRs and 95% CI in underweight and obese II individuals were 1.10 (0.93–1.30) and 2.223 (1.99–2.49) in the age 20–39 group, whereas 0.97 (0.93–1.01) and 1.03 (0.98–1.08) in the age over 65 years old. Conclusions Underweight as well as obesity was associated with increased risks of AF and IS in the general population. In both AF and IS, the gradient of risks according to BMI was apparent at young ages; thus, maintaining normal body weight should be warranted in early life. An interplay of several factors other than BMI may contribute to ischemic stroke in the old ages, requiring integrated risk management in older patients. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Acute cardiovascular events and all-cause mortality in patients with hyperthyroidism: a population-based cohort study

2017 ◽  
Vol 176 (1) ◽  
pp. 1-9 ◽  
Author(s):  
Olaf M Dekkers ◽  
Erzsébet Horváth-Puhó ◽  
Suzanne C Cannegieter ◽  
Jan P Vandenbroucke ◽  
Henrik Toft Sørensen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Ischemic Stroke ◽  
Cardiovascular Events ◽  
Population Based ◽  
Arterial Embolism ◽  
Registration System ◽  
Increased Risk ◽  
All Cause Mortality

Objective Several studies have shown an increased risk for cardiovascular disease (CVD) in hyperthyroidism, but most studies have been too small to address the effect of hyperthyroidism on individual cardiovascular endpoints. Our main aim was to assess the association among hyperthyroidism, acute cardiovascular events and mortality. Design It is a nationwide population-based cohort study. Data were obtained from the Danish Civil Registration System and the Danish National Patient Registry, which covers all Danish hospitals. We compared the rate of all-cause mortality as well as venous thromboembolism (VTE), acute myocardial infarction (AMI), ischemic and non-ischemic stroke, arterial embolism, atrial fibrillation (AF) and percutaneous coronary intervention (PCI) in the two cohorts. Hazard ratios (HR) with 95% confidence intervals (95% CI) were estimated. Results The study included 85 856 hyperthyroid patients and 847 057 matched population-based controls. Mean follow-up time was 9.2 years. The HR for mortality was highest in the first 3 months after diagnosis of hyperthyroidism: 4.62, 95% CI: 4.40–4.85, and remained elevated during long-term follow-up (>3 years) (HR: 1.35, 95% CI: 1.33–1.37). The risk for all examined cardiovascular events was increased, with the highest risk in the first 3 months after hyperthyroidism diagnosis. The 3-month post-diagnosis risk was highest for atrial fibrillation (HR: 7.32, 95% CI: 6.58–8.14) and arterial embolism (HR: 6.08, 95% CI: 4.30–8.61), but the risks of VTE, AMI, ischemic and non-ischemic stroke and PCI were increased also 2- to 3-fold. Conclusions We found an increased risk for all-cause mortality and acute cardiovascular events in patients with hyperthyroidism.

scholarly journals Anticoagulation trends in adults aged 65 and over with atrial fibrillation; a cohort study

2021 ◽  
Author(s):  
J Lund ◽  
CL Saunders ◽  
D Edwards ◽  
J Mant
Keyword(s):  
Atrial Fibrillation ◽  
General Practice ◽  
Cohort Study ◽  
Older People ◽  
Age Groups ◽  
Single Type ◽  
Survivor Function ◽  
Barriers To Screening ◽  
Flu Vaccination ◽  
Time Period

AbstractObjectiveTo describe patterns of anticogulation prescribing and persistence for those aged ≥65 years with atrial fibrillation (AF).MethodsDescriptive cohort study using electronic general practice records of patients in England who attended a flu vaccination aged ≥65, and were diagnosed with AF between 2008-2018. Patients were stratified by 10 year age group and year of diagnosis. Proportion anticoagulated, type of anticoagulation (direct oral anticoagulant (DOAC) or Warfarin) initiated at diagnosis, and persistence with anticoagulation over time are reported.Results42,290 patients (49% female), aged 65-74 (n=11,722), 75-84 (n=19,055) and 85+ (n=11,513) at AF diagnosis are included. Prescription of anticoagulation at diagnosis increased over the time period from 55% to 86% in people aged 65-74, from 54% to 86% in people aged 75-84 and from 27% to 75% in people aged 85 and over. No patients were prescribed DOACs as a first anticoagulation agent in 2008, by 201892% of new AF patients were started on DOACs. Survivor function for 5 year persistence for patients taking only a single type of anticoagulant was 0.80 (0.77:0.82) for DOACs and0.71(0.70:0.72) for warfarin, Survivor function for any anticoagulation at 5 years was0.79(0.78:0.81), 0.73(0.72:0.75), 0.58(0.59:0.64) for people aged 65-74, 75-84 and 85+ respectively.ConclusionsRates of anticoagulation for new AF in those aged ≥65 have increased from 2008 to 2018, over which time there has been a shift from initiating anticoaguation with warfarin to DOACs. Persistence with anticoagulation is higher in people on DOACs than on warfarin, and in people under the aged of 85.Key MessagesWhat is already known?Anticoagulation is a highly effective way of reducing the risk of stroke associated with AF, but is underused, particularly in older people. The introduction of DOACs has been associated with increasing use of anticoagulation in AF.What does this study add?Our study provides up to date information on anticoagulation for AF in older people who are most at risk of AF related stroke and highlights particular increases in use of anticoagulation in people aged 85 and over.DOACs are now the major class of anticoagulant prescribed to patients with new AF in UK general practice.Long term persistence with anticoagulation is higher with DOACs than warfarin, but drops in all age groups over 5 years.How might this impact on clinical practice?Improved uptake of anticoagulation at all ages removes one of the potential barriers to screening for atrial fibrillation, but new strategies may be needed to enhance longer term persistence with treatment.

Abstract 160: Impact of Medication Adherence on Risk of Stroke, Major Bleeding and Other Outcomes in Atrial Fibrillation Patients Using Novel Oral Anticoagulants (Dabigatran and Rivaroxaban)

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Chinmay G Deshpande ◽  
Cynthia Willey Temkin ◽  
Robert Laforge ◽  
Stephen Kogut
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Drug Use ◽  
Propensity Score ◽  
Major Bleeding ◽  
Cox Regression ◽  
Oral Anticoagulants ◽  
Cox Models ◽  
Adherence Assessment ◽  
The Impact

Introduction: Dabigatran and Rivaroxaban have shown better or similar efficacy to lower stroke risk compared to warfarin in clinical trials. Evidence suggests adherence to cardiac drugs tend to reduce outcomes and cost. Our study is the first to examine the impact of atleast 6 to 12 month adherence to NOACs on ischemic stroke, major bleeding, Deep Vein Thrombosis and Pulmonary Embolism (DVTPE) risk in a propensity score based matched sample. Methods: A retrospective cohort study utilized de-identified data from Optum® Clinformatics™ Data Mart database (OptumInsight, Eden Prairie, MN) (Jan 1, 2010 and Dec 31, 2012). Adult patients with ≥ 1 diagnosis of atrial fibrillation or flutter (ICD9 427.31/32), >1 prescription of NOACs, 6 months pre-index continuous enrollment and CHA2DS2VASC score >1 were included. Adherence was calculated using Proportion of Days Covered (PDC ≥80%) for atleast 6 and 12 months of NOAC use and cohorts (adherent vs. non adherent) were matched on propensity score using Inverse Probability Treatment Weighting (IPTW) controlling for demographic and clinical characteristics at baseline. The risk of ischemic stroke, major bleeding (primary outcomes) and DVTPE (exploratory outcome) was evaluated for the matched cohorts post adherence assessment using Cox regression. Results: Out of 25,150 NOAC patients, a total of 3,629 and 1,946 patients with atleast 6 and 12 months of NOAC use were included. Across 2 cohorts, the mean age of the sample was 65 years, 65% were males and >60% had a moderate-high risk of stroke (CHA2DS2VASC>2). Adherence (PDC ≥80%) was 77% and 76% for patients with 6 and 12 month drug use. Post 12 months of drug use, the overall incidence of bleeding, stroke, and DVTPE in the follow-up period was 4.42%, 1.80%, and 0.82% respectively. Each outcome was analyzed separately to avoid calculation of competing risks. Using Cox models with IPTW balanced cohorts, non-adherence was significantly (p ≤0.05) associated with an increase in stroke (≥ 1.5 fold) and DVTPE (≥ 2 fold) risk in both 6 and 12 month users. The risk of bleeding was not significantly different across adherent vs. non adherent users (Table). Conclusion: In our sample, adherence to NOACs was associated with a reduction in stroke and DVTPE risk but did not substantially increase bleeding risk. Further studies with newer NOACs are warranted.

Incidence and predictors of left atrium thrombus in acute ischemic stroke patients without atrial fibrillation: a single center cohort study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Cinar ◽  
M.I Hayiroglu ◽  
V Cicek ◽  
S Asal ◽  
M.M Atmaca ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Left Atrium ◽  
Characteristic Curve ◽  
Multivariate Logistic Regression Analysis ◽  
Single Center ◽  
Stroke Patients ◽  
Previous Diagnosis

Abstract Introduction The present study aimed to determine independent predictors of left atrial thrombus (LAT) in acute ischemic stroke patients without atrial fibrillation (AF) using transesophageal echocardiography (TEE). Material and methods In this single center, retrospective cohort study, we enrolled 149 consecutive acute ischemic stroke patients. All of the patients underwent TEE examination to detect LAT within 10 days following admission. Multivariate logistic regression analysis was performed to assess independent predictors of LAT. Results Among all cases, 14 patients (9.3%) had a diagnosis of LAT on TEE examination. In a multivariate analysis; a previous diagnosis of cerebrovascular accident, elevated mean platelet volume (MPV), low left ventricle ejection fraction (EF) and a reduced left atrium appendix (LAA) peak emptying velocity were independent predictors of LAT. The area of MPV under the receiver operating characteristic curve analysis was 0.70 (95% CI: 0.57–0.83; p=0.011). With the optimal cut-off value of 9.45, MPV had a sensitivity of 71.4% and a specificity of 63% to predict LAT. Conclusion Patients with low ventricle EF and elevated MPV should undergo further TEE examination for the possibility of cardio-embolic source. In addition, this research may provide novel information with respect to the applicability of MPV to predict LAT in acute ischemic stroke patients without AF. Figure 1 Funding Acknowledgement Type of funding source: None

P5675Ischemic stroke in patient with sinus node disease in comparison to atrial fibrillation, bradycardia-tachycardia syndrome and other cardiac conditions: a nationwide cohort-study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Bodin ◽  
A Bisson ◽  
N Clementy ◽  
B Pierre ◽  
J Herbert ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Ischemic Stroke ◽  
Sinus Node ◽  
Control Population ◽  
National Database ◽  
Control Group ◽  
Cardiac Condition ◽  
Node Disease ◽  
Sinus Node Disease

Abstract Atrial fibrillation (AF) may be associated with sinus node disease (SND) presenting as a brady-tachy syndrome (BTS), known to be at risk for embolic ischemic stroke (IS). It remains unclear whether the risk of IS is increased in patients with isolated SND. Methods This French longitudinal cohort study was based on the national database covering hospital care from for the entire population (PMSI) from 2010 to 2015. We compared incidences of IS in patients with a diagnosis of AF or SND to that in a control group of patients with a main diagnosis of cardiac condition (excluding those with AF or SND, history of stroke and mechanical valve or mitral stenosis). Results Of 1,732,412 patients included in the cohort, 1,601,435 (92.44%) had isolated AF, 102,849 (5.94%) had isolated SND and 28,128 (1.62%) had BTS. The control group with cardiac condition included 479,108 patients. Incidence of IS progressively increased when considering patients from the control population, patients with isolated SND, with BTS or with isolated AF (0.67%/yr, 1.95%/yr, 3.03%/yr and 5.48%/yr respectively). These differences were seen in all strata of CHA2DS2VASc score (table). SND patients with a CHA2DS2-VASc score ≥3 had a yearly incidence of IS >2%, comparable to AF population with a CHA2DS2-VASc score ≥1. Incidence (%/year) of ischemic stroke CHA2DS2-VASc AF population SND population “Control” population Women Men Women Men Women Men All scores 6.72% 4.37% 1.93% 1.96% 0.67% 0.68% Score = 0 – 1.960% – 1.211% – 0.217% Score = 1 2.337% 3.046% 0.538% 1.486% 0.166% 0.345% Score = 2 3.917% 4.499% 0.879% 1.541% 0.298% 0.580% Score = 3 7.572% 4.733% 2.207% 2.084% 0.541% 0.907% Score = 4 7.016% 4.820% 2.363% 2.305% 0.930% 1.278% Score = 5 6.725% 5.345% 2.845% 2.849% 1.249% 1.553% Score = 6 7.637% 7.543% 3.319% 4.109% 1.737% 2.031% Score = 7 10.196% 13.927% 4.663% 7.708% 2.346% 4.089% Score = 8 17.654% 12.607% 8.519% 11.904% 2.446% 2.355% Conclusion Patients with isolated SND had a lower risk of IS than patients with AF or BTS. However, SND patients had a non-neglectable risk of IS during follow-up which was higher than in a “control” population. Whether oral anticoagulation may bring a significant clinical benefit might be studied in patients with SND at highest risk of IS.

408Albuminuria as a predictor of incident ischemic stroke and myocardial infarction in patients with type 2 diabetes but without cardiovascular disease: A Danish cohort study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M V Fangel ◽  
P B Nielsen ◽  
J K Kristensen ◽  
T B Larsen ◽  
T F Overvad ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Cohort Study ◽  
Ischemic Stroke ◽  
Cardiovascular Risk ◽  
All Cause Mortality ◽  
Patients With Diabetes

Abstract Background Risk stratification in patients with type 2 diabetes continues to be an important priority in the management of diabetes-related morbidity and mortality. International guidelines generally recognize patients with diabetes and cardiovascular disease as high-risk patients. Risk stratification is, however, more uncertain in diabetes patients without cardiovascular disease. Micro- and macroalbuminuria have previously been identified as predictors of cardiovascular events and mortality in general cohorts of diabetes patients. However, less is known about the predictive value of albuminuria in patients with diabetes but without established cardiovascular disease. Purpose We aimed to examine the association between albuminuria level and the risk of ischemic stroke, myocardial infarction, and all-cause mortality in patients with type 2 diabetes and without a diagnosis of cardiovascular disease. Methods We linked Danish nationwide registries to identify patients with type 2 diabetes and without cardiovascular disease from May 2005 through June 2015. Based on two consecutive measurements of the urinary albumin excretion rate or albumin-to-creatinine ratio patients were stratified in categories of normoalbuminuria, microalbuminuria, and macroalbuminuria. Patients were followed for the outcomes ischemic stroke, myocardial infarction, and all-cause mortality until December 31, 2015. Five-year risk of outcomes were presented as cumulative incidence functions (with death as a competing event). Associations between albuminuria level and incidence of ischemic stroke, myocardial infarction, and all-cause mortality were evaluated with Cox proportional hazard regression adjusted for cardiovascular risk factors. Results The study population included 78,841 patients with type 2 diabetes (44.7% females, mean age 63.2). When comparing patients with microalbuminuria to patients with normoalbuminuria in an age- and sex-adjusted analysis, we found hazard ratios (HRs) of 1.45 (95% CI: 1.24–1.69), 1.45 (95% CI: 1.24–1.70), and 1.50 (95% CI: 1.39–1.61) for ischemic stroke, myocardial infarction, and all-cause mortality, respectively. Furthermore, macroalbuminuria was associated with HRs of 2.05 (95% CI: 1.70–2.48), 2.25 (95% CI: 1.86–2.71), and 2.03 (95% CI: 1.85–2.23) for ischemic stroke, myocardial infarction, and all-cause mortality, respectively. Similar results were found after adjusting for cardiovascular risk factors. Conclusions In this nationwide cohort study of patients with type 2 diabetes but without cardiovascular disease, patients with micro- and macroalbuminuria had a higher risk of incident ischemic stroke, myocardial infarction, and all-cause mortality. This finding supports that patients with micro- or macroalbuminuria should be screened regularly and followed closely in clinical practice. Moreover, these findings suggest that patients with type 2 diabetes and micro- or macroalbuminuria may benefit from intensive vascular risk reduction.

scholarly journals Association of Preceding Antithrombotic Therapy in Atrial Fibrillation Patients With Ischemic Stroke, Intracranial Hemorrhage, or Gastrointestinal Bleed and Mortality

2019 ◽  
Author(s):  
Joris J Komen ◽  
Tomas Forslund ◽  
Aukje K Mantel-Teeuwisse ◽  
Olaf H Klungel ◽  
Mia von Euler ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Propensity Score ◽  
Intracranial Hemorrhage ◽  
Cox Regression ◽  
Mortality Rates ◽  
Antithrombotic Treatment ◽  
Healthcare Database ◽  
Gastrointestinal Bleed ◽  
History Of

Abstract Aims To analyze 90-day mortality in AF patients after a stroke or a severe bleed and assess associations with the type of antithrombotic treatment at the event. Methods and Results From the Stockholm Healthcare database, we selected 6 017 patients with a known history of AF who were diagnosed with ischemic stroke, 3 006 with intracranial hemorrhage, and 4 291 with a severe gastrointestinal bleed (GIB). The 90-day mortality rates were 25.1% after ischemic stroke, 31.6% after intracranial hemorrhage, and 16.2% after severe GIB. We used Cox regression and propensity score matched analyses to test the association between antithrombotic treatment at the event and 90-day mortality. After intracranial hemorrhage, there was a significantly higher mortality rate in warfarin compared to NOAC treated patients (adjusted hazard ratio (aHR): 1.36 CI: 1.04 – 1.78). After an ischemic stroke and a severe GIB, patients receiving antiplatelets or no antithrombotic treatment had significantly higher mortality rates compared to patients on NOACs, but there was no difference comparing warfarin to NOACs (aHR 0.84 CI: 0.63 – 1.12 after ischemic stroke, aHR 0.91 CI: 0.66 – 1.25 after severe GIB). Propensity score matched analysis yielded similar results. Conclusion Mortality rates were high in AF patients suffering from an ischemic stroke, an intracranial hemorrhage, or a severe GIB. NOAC treatment was associated with a lower 90 day mortality after intracranial hemorrhage than warfarin.

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