scholarly journals Higher Long-term Visit-to-Visit Glycemic Variability Predicts New-Onset Atrial Fibrillation in Patients with Diabetes Mellitus

2021 ◽  
Author(s):  
Jung-Chi Hsu ◽  
Yen-Yun Yang ◽  
Shu-Lin Chuang ◽  
Chih-Chieh Yu ◽  
Lian-Yu Lin
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Cox Regression ◽  
Total Mortality ◽  
Glycemic Variability ◽  
University Hospital ◽  
Cardiac Mortality ◽  
Increased Risk ◽  
New Onset

Abstract BackgroundAtrial fibrillation (AF) is prevalent in patients with type 2 diabetes mellitus (T2DM). Glycemic variability (GV) is associated with risk of micro- and macrovascular diseases. However, whether the GV can increase the risk of AF remains unknown.MethodsThe cohort study used a database from National Taiwan University Hospital, a tertiary medical center in Taiwan. Between 2014 and 2019, a total of 27246 adult patients with T2DM were enrolled for analysis. Each individual was assessed to determine the coefficients of variability of fasting glucose (FGCV) and HbA1c variability score (HVS). The GV parameters were categorized into quartiles. Multivariate Cox regression models were employed to estimate the relationship between the GV parameters and the risk of AF, transient ischemic accident (TIA)/ischemic stroke and mortality in patients with T2DM.ResultsThe incidence rates of AF and TIA/ischemic stroke were 21.31 and 13.71 per 1000 person-year respectively. The medium follow-up period was 70.7 months. In Cox regression model with full adjustment, the highest quartiles of FGCV was not associated with increased risk of AF (Hazard ratio (HR): 1.11, 95% confidence interval (CI): 0.96-1.29, p=0.165) or TIA/ischemic stroke (HR: 1.03, 95% CI: 0.82-1.29, p=0.821), but was associated with increased risk of total mortality (HR: 1.34, 95% CI: 1.13-1.60, p<0.001) and non-cardiac mortality (HR: 1.42, 95% CI: 1.17-1.72, p<0.001). The highest HVS was significantly associated with increased risk of AF (HR: 1.29, 95% CI: 1.12-1.48, p<0.001), total mortality (HR: 2.44, 95% CI: 2.04-2.91, p<0.001), cardiac mortality (HR: 1.48, 95% CI: 1.04-2.10, p=0.028) and non-cardiac mortality (HR: 2.83, 95% CI: 2.31-3.14, p<0.001) but was not associated with TIA/ischemic stroke (HR: 1.00, 95% CI: 0.79-1.26, p=0.989). The Kaplan-Meier analysis showed significantly higher risk of AF, cardiac and non-cardiac mortality according to the magnitude of GV(log-rank<0.001). ConclusionsHigher GV is independently associated with the development of new-onset AF in patients with T2DM. Reducing GV may be a potential new therapeutic target to prevent AF.

scholarly journals Higher long-term visit-to-visit glycemic variability predicts new-onset atrial fibrillation in patients with diabetes mellitus

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Jung-Chi Hsu ◽  
Yen-Yun Yang ◽  
Shu-Lin Chuang ◽  
Chih-Chieh Yu ◽  
Lian-Yu Lin
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Cox Regression ◽  
Total Mortality ◽  
Glycemic Variability ◽  
Rank Test ◽  
Cardiac Mortality ◽  
Increased Risk ◽  
New Onset

Abstract Background Atrial fibrillation (AF) is prevalent in patients with type 2 diabetes mellitus (T2DM). Glycemic variability (GV) is associated with risk of micro- and macrovascular diseases. However, whether the GV can increase the risk of AF remains unknown. Methods The cohort study used a database from National Taiwan University Hospital, a tertiary medical center in Taiwan. Between 2014 and 2019, a total of 27,246 adult patients with T2DM were enrolled for analysis. Each individual was assessed to determine the coefficients of variability of fasting glucose (FGCV) and HbA1c variability score (HVS). The GV parameters were categorized into quartiles. Multivariate Cox regression models were employed to estimate the relationship between the GV parameters and the risk of AF, transient ischemic accident (TIA)/ischemic stroke and mortality in patients with T2DM. Results The incidence rates of AF and TIA/ischemic stroke were 21.31 and 13.71 per 1000 person-year respectively. The medium follow-up period was 70.7 months. In Cox regression model with full adjustment, the highest quartile of FGCV was not associated with increased risk of AF [Hazard ratio (HR): 1.12, 95% confidence interval (CI) 0.96–1.29, p = 0.148] or TIA/ischemic stroke (HR: 1.04, 95% CI 0.83–1.31, p = 0.736), but was associated with increased risk of total mortality (HR: 1.33, 95% CI 1.12–1.58, p < 0.001) and non-cardiac mortality (HR: 1.41, 95% CI 1.15–1.71, p < 0.001). The highest HVS was significantly associated with increased risk of AF (HR: 1.29, 95% CI 1.12–1.50, p < 0.001), total mortality (HR: 2.43, 95% CI 2.03–2.90, p < 0.001), cardiac mortality (HR: 1.50, 95% CI 1.06–2.14, p = 0.024) and non-cardiac mortality (HR: 2.80, 95% CI 2.28–3.44, p < 0.001) but was not associated with TIA/ischemic stroke (HR: 0.98, 95% CI 0.78–1.23, p = 0.846). The Kaplan–Meier analysis showed significantly higher risk of AF, cardiac and non-cardiac mortality according to the magnitude of GV (log-rank test, p < 0.001). Conclusions Our data demonstrate that high GV is independently associated with the development of new-onset AF in patients with T2DM. The benefit of maintaining stable glycemic levels to improve clinical outcomes warrants further studies.

Abstract 12096: Temporal Trends in Ischemic Stroke and Anticoagulation Therapy Among Medicare Beneficiaries Having Non-Valvular Atrial Fibrillation With and Without Diabetes Mellitus, 1992-2010

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Gautam R Shroff ◽  
Craig A Solid ◽  
Charles A Herzog
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Temporal Trends ◽  
Significant Proportion ◽  
Anticoagulation Therapy ◽  
Medicare Beneficiaries ◽  
Similar Reduction ◽  
Increased Risk ◽  
Patients With Diabetes

Background: Patients with diabetes mellitus (DM) and non valvular atrial fibrillation (AF) are at increased risk of ischemic stroke; but evidence regarding ischemic stroke and warfarin use in the literature is limited. We evaluated temporal trends in ischemic stroke and warfarin use among the US Medicare population with and without DM. Methods: One-year cohorts of patients with Medicare as primary payer, 1992-2010, were created using the Medicare 5% sample. ICD-9-CM codes were used to identify AF, ischemic and hemorrhagic stroke and comorbidities; ≤3 consecutive prothrombin-time claims were used to identify warfarin use. Results: Demographic characteristics between 1992 (n=40255) and 2010 (n=80314) respectively were (proportions): age 65-74 years (37%, 32%); age ≤ 85 years (20%, 25%); white (94%, 93%); hypertension (46%, 80%); DM (20%, 32%), chronic kidney disease (5%, 18%). Ischemic stroke rates among Medicare AF patients with DM decreased by 71% (1992, 2010) from 65 to 19 /1000 patient-years; warfarin utilization increased from 28% to 62% respectively (Figure 1A). Among Medicare AF patients without DM, ischemic stroke rates decreased by 68% from 44 to 14/ 1000 patient-years; warfarin use increased 26% to 59% respectively (Figure 1B). About 38% Medicare AF pts with DM did not receive anticoagulation in 2010. Conclusion: Medicare patients with and without DM had a similar reduction in ischemic stroke rates; and similar increase in warfarin utilization over the study period. A significant proportion of Medicare pts with DM did not receive anticoagulation with warfarin for AF in 2010; this population deserves future attention.

P2463Advanced interatrial block is a surrogate for left atrial strain reduction which predicts atrial fibrillation and stroke

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Lacalzada Almeida ◽  
V Armarnani Armarnani ◽  
J Garcia-Niebla ◽  
M M Izquierdo-Gomez ◽  
R Elosua ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Left Atrial ◽  
Cox Regression ◽  
Imaging Techniques ◽  
P Wave ◽  
Control Group ◽  
End Point ◽  
Interatrial Block ◽  
New Onset

Abstract Background The association between advanced interatrial block (aIAB) and atrial fibrillation (AF) is known as “Bayes' Syndrome”. There is little information on the prognostic role that new speckle tracking echocardiographic (STE) imaging techniques could play in it. Purpose We have examined the relationship between left atrial (LA) STE and the prediction of new-onset AF and/or stroke in IAB patients. Methods Observational study with 98 outpatients: 55 (56.2%) controls with normal ECG, 21 (21.4%) with partial IAB (pIAB) and 22 (22.4%) with aIAB. The end-point was new-onset AF, ischemic stroke, and the composite of both. Results During a mean follow-up of 1.9 (1.7–2.3) years, 20 patients presented the end-point (18 new-onset AF and 2 strokes): 8 (14.5%) in the control group, 3 (14.3%) in pIAB and 9 (40.9%) in aIAB, p=0.03. In multivariable comprehensive Cox regression analyses, a decrease of strain rate during the booster pump function phase (SRa) was the only variable independently related to the appearance in the evolution of the end-point, in the first model (age, P wave duration and SRa): HR 19.9 (95% CI, 3.12–127.5), p=0.002 and in the second (age, presence of aIAB and SRa): HR 24.2 (95% CI, 3.15–185.4), p=0.002. Conclusions In patients with IAB, a decrease in absolute value of LA SRa with STE predicts new-onset AF and ischemic stroke. Acknowledgement/Funding None

scholarly journals Underweight is a major risk factor for atrial fibrillation in Asian people with type 2 diabetes mellitus

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Jung-Chi Hsu ◽  
Yen-Yun Yang ◽  
Shu-Lin Chuang ◽  
Yi-Wei Chung ◽  
Chih-Hsien Wang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Cox Regression ◽  
Reference Group ◽  
University Hospital ◽  
Rank Test ◽  
Obesity Class

Abstract Background Atrial fibrillation (AF) is prevalent in patients with type 2 diabetes mellitus (T2DM). Obesity commonly accompanies T2DM, and increases the risk of AF. However, the dose-relationship between body mass index (BMI) and AF risk has seldom been studied in patients with diabetes. Methods This cohort study utilized a database from National Taiwan University Hospital, a tertiary medical center in Taiwan. Between 2014 and 2019, 64,339 adult patients with T2DM were enrolled for analysis. BMI was measured and categorized as underweight (BMI < 18.5), normal (18.5 ≤ BMI < 24), overweight (24 ≤ BMI < 27), obesity class 1 (27 ≤ BMI < 30), obesity class 2 (30 ≤ BMI < 35), or obesity class 3 (BMI ≥ 35). Multivariate Cox regression and spline regression models were employed to estimate the relationship between BMI and the risk of AF in patients with T2DM. Results The incidence of AF was 1.97 per 1000 person-years (median follow-up, 70.7 months). In multivariate Cox regression, using normal BMI as the reference group, underweight (HR 1.52, 95% CI 1.25–1.87, p < 0.001) was associated with a significantly higher risk of AF, while overweight was associated with significantly reduced risk of AF (HR 0.82, 95% CI 0.73–0.89, p < 0.001). Kaplan–Meier analysis showed AF risk was highest in the underweight group, followed by obesity class 3, while the overweight group had the lowest incidence of AF (log-rank test, p < 0.001). The cubic restrictive spline model revealed a “J-shaped” or “L-shaped” relationship between BMI and AF risk. Conclusions Underweight status confers the highest AF risk in Asian patients with T2DM.

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.

73Hemoglobin a1c levels and the risk of ischemic stroke and mortality in individuals with diabetes mellitus and atrial fibrillation

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
L Kezerle ◽  
M A Tsadok ◽  
A Akriv ◽  
B Feldman ◽  
M Leventer-Roberts ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Dependent Manner ◽  
Historical Cohort ◽  
Increased Risk ◽  
Dose Dependent ◽  
Hba1c Levels

Abstract Funding Acknowledgements Pfizer Israel Background Diabetes mellitus (DM) is associated with increased risk of embolic complications in non-valvular atrial fibrillation (NVAF). Whether the risk of stroke in AF patients remains the same among the wide spectrum of disease is yet to be determined. Aim Among individuals with AF and DM, to assess the incidence rates and risk of ischemic stroke and mortality by baseline HbA1C levels. Methods We conducted a prospective, historical cohort study using the Clalit Health Services (CHS) electronic medical records database. The study population included all CHS members ≥ 21 years old, with a first diagnosis of NVAF between January 1, 2010 to December 31, 2016 and a minimal follow-up period of 1 year. Among those patients identified as diabetics, we compared three groups of patients according to HBA1C levels at the time of AF diagnosis: &lt;7.0%, between 7-9% and ≥ 9%. Results A total of 44,451 cases were identified. The median age was 75 years (IQR 65-83) and 52.5% were women. During a mean follow up of 38 months, the incidence of stroke per 100 person-years in the three study groups was: 1.9 in patients with HBA1C &lt;7%, 2.37 in the intermediary group and 2.72 in those with HBA1C &gt;9%. In both univariate and multivariate analyses, higher levels of HBA1C were associated with an increased risk of stroke compared with a dose-dependent response when compared to individuals with HBA1C &lt;7% (Adjusted Hazard Ratio (AHR) = 1.32 {95% CI 1.12-1.55}for levels between 7-9% and AHR 1.64 {95% CI 1.28-2.09}) even after adjusting for CHA2DS2-VASC individual risk factors and use of oral anti-coagulants. The risk for overall mortality did not differ significantly between groups, with a slight elevation in the HBA1C &gt;9% group after adjusted analysis {aHR = 1.17 (1.07- 1.28)} Conclusion: In this observational cohort of patients with incident newly diagnosed nonvalvular atrial fibrillation, HBA1C levels were associated with an increased risk of stroke in a dose-dependent manner even after accounting for other recognized risk factors for stroke in this population. Abstract Figure. Kaplan-Meier for stroke-free survival

Atrial fibrillation and migraine with aura in young adults with ischemic stroke

Cephalalgia ◽  
2020 ◽  
pp. 033310242097088
Author(s):  
Cédric Gollion ◽  
Julie Gazagnes ◽  
Vincent Fabry ◽  
Marianne Barbieux-Guillot ◽  
Fleur Lerebours ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Young Adults ◽  
Ischemic Stroke ◽  
Confidence Interval ◽  
Migraine With Aura ◽  
Odds Ratio ◽  
Migraine Without Aura ◽  
University Hospital ◽  
Common Cause ◽  
Increased Risk

Background Migraine is associated with an increased risk of ischemic stroke. The associations are stronger in migraine with aura than in migraine without aura, in women than in men, and in younger subjects. However, the mechanisms by which migraine might increase the risk of ischemic stroke are debated. Methods We analysed the associations between migraine without aura and migraine with aura and the causes of ischemic stroke in patients aged 18–54 years treated consecutively in a university hospital stroke center. Results A total of 339 patients (mean/SD age 43.8/8.8 years, 62.83% male) were included. Migraine with aura was diagnosed in 58 patients, and migraine without aura in 54 patients. Patients with migraine with aura were younger and had fewer traditional cardiovascular risk factors than patients with no migraine. Migraine with aura was strongly associated with atrial fibrillation (odds ratio, 5.08; 95% confidence interval, 1.24–21.92; p = 0.011) and negatively associated with atherosclerosis (odds ratio, 0.29; 95% confidence interval, 0.05–0.97; p = 0.033) and small vessel disease (odds ratio, 0.13; 95% confidence interval, 0.00–0.87; p = 0.022). No other cause of stroke was significantly associated with migraine. The most common cause of stroke was atherosclerosis in no-migraine patients, dissection in migraine without aura patients and patent foramen ovale in migraine with aura patients. Atrial fibrillation was, together with dissection, the second leading cause of stroke in migraine with aura patients, accounting for 10.34% of cases in this subgroup. Conclusion We showed that atrial fibrillation was a common cause of ischemic stroke in young adults with migraine with aura.

scholarly journals Underweight Is A Major Risk Factor of Atrial Fibrillation In Asian People With Type 2 Diabetes Mellitus

2021 ◽  
Author(s):  
Jung-Chi Hsu ◽  
Yen-Yun Yang ◽  
Shu-Lin Chuang ◽  
Yi-Wei Chung ◽  
Lian-Yu Lin
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Regression Model ◽  
Cox Regression ◽  
Rank Test ◽  
Obesity Class ◽  
Increased Risk

Abstract Background: Atrial fibrillation (AF) is prevalent in patients with type 2 diabetes mellitus (T2DM). Obesity commonly accompanies with T2DM and increases AF incidence. However, the dose-relationship of body mass index (BMI) and the risk of AF has seldom been studied in diabetes patients.Methods: This cohort study was conducted utilizing a database from National Taiwan University Hospital, a tertiary medical center in Taiwan. Between 2014 and 2019, a total of 64339 adult patients with T2DM were enrolled for analysis. The BMI was measured and categorized into several groups including underweight (BMI <18.5), normal range (18.5≤BMI <24), overweight (24≤BMI <27), obesity class 1 (27≤BMI <30), obesity class 2 (30≤BMI <35), and obesity class 3 (BMI≥35). Multivariate Cox regression models and spline regression model were employed to estimate the relationship between BMI and the risk of AF in patients with T2DM.Results: The incidence rate of AF was 1.97 per 1000 person-year during a median follow-up period of 70.7 months. In multivariate Cox regression model, by using normal BMI as reference group, individuals with underweight (HR 1.47, 95%CI 1.19-1.81, p<0.001) was significantly associated with increased risk of AF while overweight was significantly associated with reduced risk of AF (HR 0.83, 95%CI 0.76-0.91, p<0.001). The Kaplan-Meier analysis showed that the risk of AF was highest in the underweight group, followed by obesity class 3, while the overweight group had the least incidence of AF (log-rank test, p<0.001). Cubic restrictive spline model showed a “J-shaped” or “L-shape” relationship between BMI and the risk AF.Conclusions: We found that underweight carries the highest risk of AF in Asian patients with T2DM.

3053High mortality in atrial fibrillation patients suffering ischemic stroke, intracranial hemorrhage or a gastrointestinal bleed and associations with the preceding antithrombotic treatment

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J J Komen ◽  
T Forslund ◽  
A K Mantel - Teeuwisse ◽  
O H Klungel ◽  
B Wettermark ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Propensity Score ◽  
Intracranial Hemorrhage ◽  
Cox Regression ◽  
Mortality Rates ◽  
Antithrombotic Treatment ◽  
Gastrointestinal Bleed ◽  
Increased Risk ◽  
Significant Difference

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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