CHA2DS2-VASc score and risk of thromboembolism and bleeding in patients with atrial fibrillation and recent cancer

Background Cancer may influence the risk of thromboembolism and bleeding associated with the CHA2DS2-VASc score. We examined the risk of thromboembolism and bleeding associated with the CHA2DS2-VASc score in atrial fibrillation patients with and without recent cancer. Methods and results Using nationwide registers all patients diagnosed with atrial fibrillation from 2000 to 2015 and not on oral anticoagulation or heparin therapy were included and followed for 2 years. Recent cancer was defined by a cancer diagnosis 5 years or fewer earlier. Risks of thromboembolism and bleeding were estimated in cumulative incidence curves and Cox regression models. We included 122,053 patients with incident atrial fibrillation, 12,014 (10%) had recent cancer. The 2-year cumulative incidence of thromboembolism and bleeding in patients with versus without recent cancer was 1.7% (95% confidence interval (CI) 0.5–2.8) and 4.3% (95% CI 2.4–6.2) versus 1.2% (95% CI 0.9–1.5) and 1.7% (95% CI 1.4–2.0) for CHA2DS2-VASc score 0; 3.2% (95%CI 2.2-4.3) and 4.4% (95%CI 3.2-5.6) versus 1.8% (95%CI 1.6-2.1) and 3.0% (95% CI 2.7–3.3) for CHA2DS2-VASc score 1; and 7.1% (95% CI 6.6–7.7) and 6.8% (95% CI 6.3–7.2) versus 10.9% (95% CI 10.7–11.1) and 6.2% (95% CI 6.1–6.4) for CHA2DS2-VASc score 2 or greater. Although the CHA2DS2-VASc score was associated with thromboembolism and bleeding in both patients with and without cancer, the association differed between the groups for thromboembolism (test for interaction, p < 0.001) and bleeding (test for interaction, p < 0.001). Conclusion The association of the CHA2DS2-VASc score and risk of thromboembolism and bleeding differed between atrial fibrillation patients with and without recent cancer. Therefore, the CHA2DS2-VASc score should be used with caution in patients with recent cancer.

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Management and impact of atrial fibrillation in the COVID 19 era; concomitancy of two procoagulant phenomena

European Heart Journal ◽

10.1093/eurheartj/ehab724.2977 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

A Arteagoitia ◽

J M Monteagudo ◽

S Antonana ◽

A Gonzalez ◽

R Ortega ◽

...

Keyword(s):

Atrial Fibrillation ◽

Anticoagulant Therapy ◽

Cox Regression ◽

Heparin Therapy ◽

Cox Regression Analysis ◽

Funding Sources ◽

Subcutaneous Heparin ◽

Therapy Strategy ◽

Comorbidity Index ◽

The Impact

Abstract Background Atrial fibrillation (AF) is a widespread cause of prothrombotic state leading to long-term anticoagulant therapy. Literature describes coagulopathy as a key pathogenic mechanism of COVID-19 disease. Thus, antithrombotic therapy management is still a therapeutic challenge. During hospitalization, changing oral anticoagulant (OAC) therapies into subcutaneous heparin is common in daily clinical practice. Purpose The primary endpoint of this study is to analyze the impact of AF in mortality within 30 day since admission of COVID-19 patients. The secondary endpoint is to analyze the impact of the anticoagulant therapy strategy (therapeutic dose of subcutaneous heparin vs. OAC) in 30-day mortality of hospitalized COVID-19 patients with AF. Methods A total of 1001 consecutive patients hospitalized in our centre between 22nd August and 9th January 2021 with a confirmed microbiological diagnosis of COVID-19 by PCR were prospectively included. Of them, 134 had a previous diagnose of AF (13.5%). Cox regression analysis was performed to assess the impact of AF and the choice of anticoagulant therapy in 30-day mortality after adjusting for comorbidity (Charlson Comorbidity Index). Results After adjusting for comorbidities, AF was not independently associated with a higher 30-day mortality in patients hospitalized due to COVID-19 infection (HR 1.04, CI 0.77–1.43, p=0.760). In the group of patients with AF, changing OAC to heparin therapy was not associated with an improved prognosis (HR 0.85, CI 95% 0.46–1.56, p=0.604). Conclusions AF is not an independent prognostic factor in COVID-19 hospitalized patients. In hospitalized COVID-19 patients with AF, changing OAC to heparin therapy is not related to an improved prognosis. FUNDunding Acknowledgement Type of funding sources: None. Mortality heparin vs NOAC or AVK

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P5979Impact of disease stage on performance of strain markers for prediction of atrial fibrillation

European Heart Journal ◽

10.1093/eurheartj/ehz746.0700 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S Ramkumar ◽

F Pathan ◽

H Kawakami ◽

A Ochi ◽

H Yang ◽

...

Keyword(s):

Atrial Fibrillation ◽

Predictive Value ◽

Regression Models ◽

Cox Regression ◽

Global Longitudinal Strain ◽

Disease Stage ◽

Risk Levels ◽

Lv Dysfunction ◽

Lv Mass

Abstract Background Efforts to predict incident atrial fibrillation (AF) may be associated with complications, and there is interest in AF prediction in primary prevention (PP; pts with risk factors) and secondary prevention (SP; pts with possible AF complications). These pts have different risk levels, we sought whether that influenced the predictive value of LV dysfunction (measured as global longitudinal strain, GLS) or LA dysfunction (LA reservoir strain). Methods The PP cohort comprised 351 community-based pts ≥65 years with ≥1 risk factor for AF (age 70±4y,43% male, median follow-up 22 months) and the SP cohort comprised 532 pts after transient ischaemic attack or stroke (age 68±12y, 51% male, median follow-up 36 months). GLS and LA strain were measured offline (Image Arena-Tomtec, Germany). AF was diagnosed by 12 lead ECG, Holter or by single lead monitor. The clinical and echocardiographic characteristics of those with AF were compared to those in sinus rhythm. Nested Cox-regression models were used to assess for independent and incremental predictive value of LA strain/GLS in both cohorts. Results Compared to SP, PP had higher clinical AF risk (CHARGE-AF 5.6±5.5% vs 4.7±12.1%, p=0.02) but a lower thromboembolic risk (CHA2DS2-VASC 3±2 vs. 4±2, p<0.001). AF developed in 42 PP pts (12%) and 61 SP (12%). AF patients were older, with higher CHARGE-AF score, LA volume and LV mass. Pts developing AF had reduced GLS (17±4% vs. 20±3%, p<0.001), reservoir (28±11% vs. 35±8%, p<0.001) and pump strain (13±7% vs. 17±5%, p<0.001). GLS and LA strain had greater AUC in SP (0.84 vs 0.58 for GLS and 0.85 vs 0.57 for reservoir strain, both p<0.001). Nested cox-regression models showed that LA reservoir strain was independently associated with AF in both cohorts (p<0.05). GLS was only independently associated with incident AF in SP (Figure). Conclusion LA reservoir strain is independently associated with AF in different risk cohorts and its effect is incremental to clinical parameters and LA volume. GLS may be more useful in AF risk assessment in those in SP. Acknowledgement/Funding This study was partially supported by the Tasmanian Community Fund and Siemens Healthcare Australia.

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Trends in the Cumulative Incidence of Vocational Rehabilitation Indicators in Brazil, 2007–2016

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17113952 ◽

2020 ◽

Vol 17 (11) ◽

pp. 3952

Author(s):

Cristiano Barreto de Miranda ◽

João Silvestre Silva-Junior ◽

Gisele Aparecida Fernandes ◽

Frida Marina Fischer

Keyword(s):

Open Access ◽

Confidence Interval ◽

Vocational Rehabilitation ◽

Cumulative Incidence ◽

Regression Models ◽

Linear Regression Models ◽

Disability Benefits ◽

The Public ◽

Increasing Trend ◽

The Mean

Vocational rehabilitation (VR) aims at improving work ability to facilitate workers’ return to work. VR is provided in Brazil by the public social security system. The aim of the present study was to analyze trends in VR indicators for Brazil from 2007 to 2016. Based on open-access, secondary aggregate data, we calculated the cumulative incidence of VR indicators. We fitted Prais-Winsten generalized linear regression models to estimate trends and calculated annual percent variation with the corresponding 95% confidence interval (95% CI). The mean cumulative incidence of referrals to VR services was 37.16/1000 temporary disability benefits granted and exhibited a decreasing trend of −6.92% (95% CI: −8.38; −5.43). The mean cumulative incidence of admissions to VR services was 57.34/100 referrals and exhibited an increasing trend of 3.31% (95% CI: 1.13; 5.53). The mean cumulative incidence of rehabilitation was 57.43/100 admissions and remained stable along the analyzed period, −2.84 (95% CI: −5.87; 0.29). Our findings evidence a reduction in the number of workers referred for VR, an increase of admissions, and stability in the cumulative incidence of rehabilitated workers.

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Severe Acute Kidney Injury and Mortality in Extremely Low Gestational Age Neonates

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.18841220 ◽

2021 ◽

Vol 16 (6) ◽

pp. 862-869

Author(s):

Sangeeta Hingorani ◽

Robert H. Schmicker ◽

Patrick D. Brophy ◽

Patrick J. Heagerty ◽

Sandra E. Juul ◽

...

Keyword(s):

Confidence Interval ◽

Gestational Age ◽

Regression Models ◽

Cox Regression ◽

Controlled Trial ◽

Hazard Ratio ◽

Time Dependent ◽

Recombinant Erythropoietin ◽

The Relationship ◽

Extremely Low Gestational Age

Background and objectivesAKI is associated with poor short- and long-term outcomes. Questions remain about the frequency and timing of AKI, and whether AKI is a cause of death in extremely low gestational age neonates.Design, setting, participants, & measurementsThe Recombinant Erythropoietin for Protection of Infant Kidney Disease Study examines the kidney outcomes of extremely low gestational age neonates enrolled in the Preterm Epo Neuroprotection study, a randomized, placebo-controlled trial of recombinant human erythropoietin. We included 900 of 941 patients enrolled in Preterm Epo Neuroprotection. Baseline characteristics were compared by primary exposure (severe AKI versus none/stage 1 AKI) using unadjusted logistic regression models. Cox regression models estimated the relationship between severe AKI and death after adjustment for potential confounders. Time-dependent AKI was modeled as a binary outcome and a categorical variable by stage of AKI. We fit Cox models using time-dependent AKI status lagged by <7 days before death. Landmark analyses examined the relationship of death with development of severe AKI.ResultsSevere AKI occurred in 168 of 900 (19%, 95% confidence interval, 17% to 20%) neonates, and stage 3 AKI occurred in 60 (7%, 95% confidence interval, 5% to 8%). Stage 3 AKI occurring 7 days before death (hazard ratio, 3.88; 95% confidence interval, 1.26 to 11.96), intraventricular hemorrhage (hazard ratio, 2.01; 95% confidence interval, 1.01 to 3.99) and sepsis (hazard ratio, 2.85; 95% confidence interval, 1.12 to 7.22) were all independently associated with death. Severe AKI occurring 7 days before death (hazard ratio, 2.21; 95% confidence interval, 0.92 to 5.26) was associated with death but not statistically significant. In a landmark analysis, after adjusting for potential confounders, late (after day 14 and before day 28) severe AKI was strongly associated with higher hazard of death (hazard ratio, 4.57; 95% confidence interval, 1.82 to 11.5).ConclusionsSevere AKI occurs frequently in extremely low gestational age neonates. Stage 3 AKI is associated with mortality, and this association is present 7 days before death.

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Biomarker-Based Risk Prediction With The ABC-AF Scores in Patients With Atrial Fibrillation Not Receiving Oral Anticoagulation

Circulation ◽

10.1161/circulationaha.120.053100 ◽

2021 ◽

Author(s):

Alexander P. Benz ◽

Ziad Hijazi ◽

Johan Lindbäck ◽

Stuart J. Connolly ◽

John W. Eikelboom ◽

...

Keyword(s):

Atrial Fibrillation ◽

Oral Anticoagulation ◽

Cox Regression ◽

Troponin T ◽

Risk Estimation ◽

Clinical History ◽

Risk Scores ◽

Bleeding Score ◽

One Year ◽

Event Rates

Background: The novel ABC (Age, Biomarkers, Clinical History) scores outperform traditional risk scores for stroke, major bleeding and death in patients with atrial fibrillation (AF) receiving oral anticoagulation. To refine their utility, the ABC-AF scores needed to be validated in patients not receiving oral anticoagulation. Methods: We measured plasma levels of the ABC biomarkers (N-terminal pro-B-type natriuretic peptide, cardiac troponin-T and growth-differentiation factor-15) to apply the previously developed ABC-AF scores in patients with AF receiving aspirin (n=3,195) or aspirin and clopidogrel (n=1,110) in two large clinical trials. Calibration was assessed by comparing estimated with observed one-year risks. Cox-regression models were used for recalibration. Discrimination was evaluated separately for the aspirin only and the overall cohort (n=4,305). Results: The ABC-AF-stroke score yielded a c-index of 0.70 (95% confidence interval [CI] 0.67-0.73) in both cohorts. The ABC-AF-bleeding score had a c-index of 0.76 (95% CI 0.71-0.81) in the aspirin only cohort and 0.73 (95% CI 0.69-0.77) overall. Both scores were superior to risk scores recommended by current guidelines. The ABC-AF-death score yielded a c-index of 0.78 (95% CI 0.76-0.80) overall. Calibrated in patients receiving oral anticoagulation, the ABC-AF-stroke score underestimated, and the ABC-AF-bleeding score overestimated the risk of events in both cohorts. These scores were recalibrated for prediction of absolute event rates in the absence of oral anticoagulation. Conclusions: The biomarker-based ABC-AF scores showed better discrimination than traditional risk scores and were recalibrated for precise risk estimation in patients not receiving oral anticoagulation. They can now provide improved decision support regarding treatment of an individual patient with AF.

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Abstract P021: Oral Anticoagulant Use and Risk of Incident Dementia in Persons With Atrial Fibrillation

Circulation ◽

10.1161/circ.137.suppl_1.p021 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Nemin Chen ◽

Richard F MacLehose ◽

Lin Y Chen ◽

Faye L Norby ◽

Lindsay G Bengtson ◽

...

Keyword(s):

Atrial Fibrillation ◽

Propensity Score ◽

Oral Anticoagulation ◽

Oral Anticoagulant ◽

Lower Risk ◽

Cox Regression ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

International Classification Of Diseases ◽

Incident Dementia

Background: Current guidelines recommend oral anticoagulation for the prevention of stroke in most patients with atrial fibrillation (AF). Direct oral anticoagulants (DOACs) are associated with lower risk of ischemic stroke and intracranial bleeding than warfarin and, therefore, may reduce risk of dementia among patients with AF. Hypothesis: AF patients initiating DOACs for stroke prevention will have lower risk of dementia than patients initiating warfarin. Methods: We used data from two US healthcare claim databases, MarketScan (2007-2015) and Optum Clinformatics (2009-2015). Using validated algorithms, we identified patients with AF who initiated oral anticoagulation. Dementia was defined as having an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code of 290.xx, 294.xx, or 331.0. Comorbidities and use of other medications were defined based on inpatient, outpatient, and pharmacy claims. We performed a series of head-to-head comparisons of different oral anticoagulants (warfarin, dabigatran, rivaroxaban, and apixaban) in propensity score-matched cohorts. In each database, multivariable-adjusted Cox regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident dementia for each comparison of propensity score-matched cohorts, adjusting for age, sex, comorbidities, use of other medications, and markers of socioeconomic status (in the Optum database only). We meta-analyzed database-specific results using a random-effects model. Results: The analysis included 307,099 AF patients from the MarketScan database and 161,346 from the Optum database, of which 6,572 and 4,391 respectively had a diagnosis of incident dementia. Mean follow up ranged between 0.7 to 2.3 years and incident of diagnosed dementia between 7 to 14 cases per 1000 person-years across different oral anticoagulant initiator groups. Patients initiating DOACs had a lower risk of incident dementia than those initiating warfarin (dabigatran: HR 0.85, 95%CI 0.71, 1.01; rivaroxaban: HR 0.85, 95%CI 0.76, 0.94; apixaban: HR 0.80, 95%CI 0.65, 0.97). There were no differences in risk of incident dementia comparing DOAC user groups (dabigatran vs. rivaroxaban: HR 1.02, 95%CI 0.79, 1.32; dabigatran vs. apixaban: HR 0.92, 95%CI 0.63, 1.36; apixaban vs. rivaroxaban: HR 1.01, 95%CI 0.86, 1.19). Conclusions: Patients with AF initiating DOACs experienced lower rates of incident dementia than warfarin users. No obvious benefit was observed for any particular DOAC in relation to dementia rates.

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Low testosterone levels are predictive for incident atrial fibrillation and ischaemic stroke in men, but protective in women – results from the FINRISK study

European Journal of Preventive Cardiology ◽

10.1177/2047487318778346 ◽

2018 ◽

Vol 25 (11) ◽

pp. 1133-1139 ◽

Cited By ~ 16

Author(s):

Tanja Zeller ◽

Renate B Schnabel ◽

Sebastian Appelbaum ◽

Francisco Ojeda ◽

Filip Berisha ◽

...

Keyword(s):

Atrial Fibrillation ◽

Confidence Interval ◽

Ischaemic Stroke ◽

Cox Regression ◽

Experimental Studies ◽

Hazard Ratio ◽

Total Testosterone ◽

Testosterone Levels ◽

Increased Risk ◽

Low Testosterone

Background Atrial fibrillation is the most common serious abnormal heart rhythm, and a frequent cause of ischaemic stroke. Recent experimental studies, mainly in orchiectomised rats, report a relationship between sex hormones and atrial electrophysiology and electroanatomy. We aimed to evaluate whether low testosterone levels are predictive for atrial fibrillation and/or ischaemic stroke in men and women. Design and methods The serum total testosterone levels were measured at baseline in a population cohort of 7892 subjects (3876 male, 4016 female), aged 25–74 years, using a commercially available immunoassay. The main outcome measure was atrial fibrillation or ischaemic stroke, whichever came first. Results During a median follow-up of 13.8 years, a total of 629 subjects (8.0%) suffered from incident atrial fibrillation ( n = 426) and/or ischemic stroke ( n = 276). Cox regression analyses, adjusted for age (used as time-scale), geographical region, total cholesterol (log), high-density lipoprotein-cholesterol (log), hypertension medication, known diabetes, smoking status, waist-hip-ratio, and time of blood drawn, documented differential predictive value of low sex-specific testosterone levels for atrial fibrillation and/or ischaemic stroke, in men and in women: Increasing levels were associated with lower risk in men (hazard ratio per one nmol/l increase 0.98 (95% confidence interval 0.93–1.00); p = 0.049). On the other hand, increasing testosterone levels were associated with higher risk in women (hazard ratio per one nmol/l increase 1.17 (95% confidence interval 1.02–1.36); p = 0.031). Conclusion Our study indicates that low testosterone levels are associated with increased risk of future atrial fibrillation and/or ischaemic stroke in men, while they are protective in women.

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Incident Atrial Fibrillation and the Risk of Stroke in Adults with Chronic Kidney Disease

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.04060318 ◽

2018 ◽

Vol 13 (9) ◽

pp. 1314-1320 ◽

Cited By ~ 11

Author(s):

Juan Jesus Carrero ◽

Marco Trevisan ◽

Manish M. Sood ◽

Peter Bárány ◽

Hong Xu ◽

...

Keyword(s):

Atrial Fibrillation ◽

Confidence Interval ◽

Stroke Risk ◽

Cox Regression ◽

Hazard Ratio ◽

Competing Risk ◽

Cox Regression Analysis ◽

Diagnostic Codes ◽

Lower Egfr ◽

Therapeutic Procedures

Background and objectivesPatients with CKD have a high risk of atrial fibrillation. Both CKD and atrial fibrillation are associated with higher risk of stroke and death. However, the effect of incident atrial fibrillation on stroke risk among patients with CKD is unknown.Design, setting, participants, & measurementsOur study included adults with CKD (eGFR<60 ml/min per 1.73 m2) without previously documented atrial fibrillation who had been in contact with health care in Stockholm, Sweden during 2006–2011. Incident atrial fibrillation was identified by administrative diagnostic codes in outpatient or inpatient care and treated as a time-updated exposure in the analysis of stroke and death risk. Stroke events and deaths were ascertained from regional and national registers with complete coverage. Covariates included demographics, comorbidities, therapeutic procedures, and medications. Multivariable Cox regression analysis and competing risk analysis (accounting for death) were used to estimate the association between incident atrial fibrillation and stroke.ResultsAmong 116,184 adults with CKD, 13,412 (12%) developed clinically recognized atrial fibrillation during a mean follow-up of 3.9 years (interquartile range, 2.3–5.7 years). Incidence of atrial fibrillation increased across lower eGFR strata: from 29.4 to 46.3 atrial fibrillations per 1000 person-years in subjects with eGFR=45–60 and <30 ml/min per 1.73 m2, respectively; 1388 (53.8 per 1000 person-years) cases of stroke and 5592 (205.1 per 1000 person-years) deaths occurred after incident atrial fibrillation compared with 6850 (16.6 per 1000 person-years) cases of stroke and 28,613 (67.5 per 1000 person-years) deaths during periods without atrial fibrillation. After adjustment, incident atrial fibrillation was associated with higher risk of stroke (hazard ratio, 2.00; 95% confidence interval, 1.88 to 2.14) and death (hazard ratio, 1.76; 95% confidence interval, 1.71 to 1.82). This was attributed to both ischemic stroke (hazard ratio, 2.11; 95% confidence interval, 1.96 to 2.28) and intracranial bleeds (hazard ratio, 1.64; 95% confidence interval, 1.42 to 1.90). Stroke risk was similar across all eGFR strata. In competing risk analyses accounting for death, the association between incident atrial fibrillation and stroke was attenuated but remained higher (subhazard ratio, 1.49; 95% confidence interval, 1.39 to 1.60).ConclusionsPatients with CKD who develop atrial fibrillation are at higher risk of stroke and death.

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Effect of external beam radiotherapy on second primary cancer risk after radical prostatectomy

Canadian Urological Association Journal ◽

10.5489/cuaj.6087 ◽

2019 ◽

Vol 14 (5) ◽

Cited By ~ 1

Author(s):

Felix Preisser ◽

Elio Mazzone ◽

Sophie Knipper ◽

Sebastiano Nazzani ◽

Marco Bandini ◽

...

Keyword(s):

Radical Prostatectomy ◽

Cumulative Incidence ◽

Regression Models ◽

Cox Regression ◽

External Beam Radiotherapy ◽

Incidence Rates ◽

Second Primary ◽

Primary Cancer ◽

Treatment Type ◽

Increased Risk

Introduction: We aimed to investigate the effect of radiotherapy (RT) in contemporary patients treated with radical prostatectomy (RP) compared to RP alone for non-metastatic prostate cancer (PCa) on the incidence of second primary cancers (SPCs). Methods: Within the Surveillance, Epidemiology, and End Results database (2004–2015), we identified patients with PCa as the only or first primary cancer, who underwent RP and RT or RP alone. Cumulative incidence plots and multivariable Cox regression models tested for SPC rate differences according to treatment type: RP and RT vs. RP alone. Subgroup analyses focused on pelvic, primary pelvic, and non-pelvic SPCs, as well as on late SPCs (>5 years after PCa diagnosis). Results: Of 152 161 patients, 7.1% (n=10 870) received RP and RT. Overall, 6.6 vs. 5.0% developed SPCs after RP and RT vs. RP alone, respectively (p<0.001). Cumulative incidence rates at 10 years after PCa diagnosis for RP and RT vs. RP were 12.0 vs. 8.7% (p<0.001), 2.0 vs. 1.2% (p<0.001), 2.1 vs. 1.3% (p<0.001), and 9.9 vs. 7.4% (p<0.001) for overall SPCs, primary pelvic SPCs, overall pelvic SPCs, and non-pelvic SPCs, respectively. Multivariable Cox regression models revealed an increased risk after RP and RT vs. RP alone for overall (hazard ratio [HR] 1.2; p<0.001), primary pelvic (HR 1.5; p<0.01), pelvic (HR1.4; p<0.001), non-pelvic (HR1.1; p<0.01), late overall (HR 1.2; p=0.01), and late non-pelvic SPCs (HR1.2; p=0.03). Conclusions: RP with RT was associated with moderately increased risk of SPCs compared to RP alone. This observation should be thoroughly discussed at informed consent and considered during followup.

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Oral anticoagulation among atrial fibrillation patients with anaemia: an observational cohort study

European Heart Journal ◽

10.1093/eurheartj/ehz155 ◽

2019 ◽

Vol 40 (46) ◽

pp. 3782-3790 ◽

Cited By ~ 4

Author(s):

Anders Nissen Bonde ◽

Paul Blanche ◽

Laila Staerk ◽

Thomas Alexander Gerds ◽

Anna Gundlund ◽

...

Keyword(s):

Atrial Fibrillation ◽

Major Bleeding ◽

Oral Anticoagulation ◽

Cox Regression ◽

Absolute Risk ◽

Vitamin K Antagonists ◽

Severe Anaemia ◽

Hazard Ratios ◽

Increased Risk ◽

Mild Anaemia

Abstract Aims To investigate the risk of stroke/thromboembolism (TE) and major bleeding associated with anaemia among patients with atrial fibrillation (AF). Also, to assess the effects of oral anticoagulation (OAC) and time in therapeutic range (TTR) with vitamin K antagonists according to level of haemoglobin (Hb). Methods and results Through administrative registry databases, we identified all Danish patients diagnosed with AF from 1997 to 2012. We included 18 734 AF patients with recent available data on Hb. Multiple Cox regression analyses were used to estimate hazard ratios and to compute standardized absolute 1-year risks of stroke/TE and major bleeding. Among included patients, 3796 (20%) had mild anaemia (Hb 6.83–7.45 mmol/L for women and Hb 6.83–8.03 mmol/L for men) and 2562 (14%) had moderate/severe anaemia (Hb <6.83 mmol/L). Moderate/severe anaemia was associated with increased risk of major bleeding and 9.1% lower median TTR compared with no anaemia. Use of OAC was associated with reduced risk of stroke/TE among patients without anaemia [standardized absolute 1-year difference −2.5%, 95% confidence interval (CI) −3.8 to −1.7%] or with mild anaemia (−2.3%, 95% CI −2.8 to −1.8%), but not with moderate/severe anaemia, (0.03%, −1.8 to +2.8%, interaction P = 0.01). Oral anticoagulation was associated with a 5.3% (95% CI 2.1–8.7%) increased standardized absolute risk of major bleeding among AF patients with moderate/severe anaemia. Conclusion Anaemia was common in patients with AF and associated with major bleeding and lower TTR. Oral anticoagulation was associated with more major bleeding, but no reduction in risk of stroke/TE among AF patients with moderate/severe anaemia.

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