Residual stroke risk despite oral anticoagulation in patients with atrial fibrillation.

Autor: Carlisle MA; Division of Cardiology, Duke University Medical Center, Durham, North Carolina., Shrader P; Division of Cardiology, Duke University Medical Center, Durham, North Carolina.; Duke Clinical Research Institute, Duke University Medical Center, Durham North Carolina., Fudim M; Division of Cardiology, Duke University Medical Center, Durham, North Carolina.; Duke Clinical Research Institute, Duke University Medical Center, Durham North Carolina., Pieper KS; Division of Cardiology, Duke University Medical Center, Durham, North Carolina.; Duke Clinical Research Institute, Duke University Medical Center, Durham North Carolina., Blanco RG; Division of Cardiology, Duke University Medical Center, Durham, North Carolina.; Duke Clinical Research Institute, Duke University Medical Center, Durham North Carolina., Fonarow GC; Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California., Naccarelli GV; Penn State Heart and Vascular Institute, Penn State Medical Center, Hershey, Pennsylvania., Gersh BJ; Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota., Reiffel JA; Division of Cardiology, Columbia University, New York, New York., Kowey PR; Division of Cardiology, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania.; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania., Steinberg BA; University of Utah, Salt Lake City, Utah., Freeman JV; Division of Cardiology, Yale University School of Medicine, New Haven, Connecticut., Ezekowitz MD; Division of Cardiology, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania.; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania., Singer DE; Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts., Allen LA; University of Colorado School of Medicine, Aurora, Colorado., Chan PS; Department of Cardiovascular Research, St. Luke's Mid America Heart Institute, Kansas City, Missouri., Pokorney SD; Division of Cardiology, Duke University Medical Center, Durham, North Carolina.; Duke Clinical Research Institute, Duke University Medical Center, Durham North Carolina., Peterson ED; Division of Cardiology, Duke University Medical Center, Durham, North Carolina.; Duke Clinical Research Institute, Duke University Medical Center, Durham North Carolina., Piccini JP; Division of Cardiology, Duke University Medical Center, Durham, North Carolina.; Duke Clinical Research Institute, Duke University Medical Center, Durham North Carolina.
Jazyk: angličtina
Zdroj: Heart rhythm O2 [Heart Rhythm O2] 2022 Sep 28; Vol. 3 (6Part A), pp. 621-628. Date of Electronic Publication: 2022 Sep 28 (Print Publication: 2022).
DOI: 10.1016/j.hroo.2022.09.018
Abstrakt: Background: Oral anticoagulation (OAC) reduces the risk of thromboembolic events in patients with atrial fibrillation (AF); however, thromboembolism (TE) still can occur despite OAC. Factors associated with residual risk for stroke, systemic embolism, or transient ischemic attack events despite OAC have not been well described.
Objective: The purpose of this study was to evaluate the residual risk of thromboembolic events in patients with AF despite OAC.
Methods: A total of 18,955 patients were analyzed in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF I and II) using multivariable Cox proportional hazard modeling. Mean age was 72 ± 10.7, and 42% were women. There were 451 outcome events.
Results: The risk of TE despite OAC increased with CHA 2 DS 2 -VASc score: 0.76 (95% confidence interval [CI] 0.63-0.92) events per 100 patient-years for CHA 2 DS 2 -VASc score <4 vs 2.01 (95% CI 1.81-2.24) events per 100-patient years for CHA 2 DS 2 -VASc score >4. Factors associated with increased risk were previous stroke or transient ischemic attack (hazard ratio [HR] 2.87; 95% CI 2.30-3.59; P <.001), female sex (HR 1.52; 95% CI 1.24-1.86; P <.001), hypertension (HR 1.50; 95% CI 1.09-2.06; P = .01), and permanent AF (HR 1.47; 95% CI 1.12-1.94; P = .001). When transient ischemic attack was excluded, the results were similar, but permanent AF was no longer significantly associated with thromboembolic events.
Conclusion: Patients with AF have a residual risk of TE with increasing CHA 2 DS 2 -VASc score despite OAC. Key risk markers include previous stroke/transient ischemic attack, female sex, hypertension, and permanent AF.
(© 2022 Heart Rhythm Society. Published by Elsevier Inc.)
Databáze: MEDLINE
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