Does prior antithrombotic therapy influence recurrence and bleeding risk in stroke patients with atrial fibrillation or atrial flutter?
| Autor: | Kristian M. Bowles, John F. Potter, Joao H. Bettencourt-Silva, Stephen J Leslie, Allan Clark, David T Gamble, Romain Buono, Anthony K. Metcalf, Phyo K. Myint, Mamas A. Mamas |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Epidemiology Clinical Decision-Making Ischemia 030204 cardiovascular system & hematology Risk Assessment 03 medical and health sciences Antithrombotic treatment 0302 clinical medicine Fibrinolytic Agents Recurrence Risk Factors Internal medicine Antithrombotic Atrial Fibrillation medicine Humans 030212 general & internal medicine Hospital Mortality Registries Stroke Aged Ischemic Stroke Retrospective Studies Aged 80 and over business.industry Incidence Atrial fibrillation medicine.disease RC666 United Kingdom Hemorrhagic Stroke Treatment Outcome Atrial Flutter Cardiology Female Cardiology and Cardiovascular Medicine business Fibrinolytic agent Atrial flutter |
| Zdroj: | European journal of preventive cardiology. 27(7) |
| ISSN: | 2047-4881 |
| Popis: | Background Whilst antithrombotic therapy is recommended in people with atrial fibrillation, little is known about the survival benefits of antithrombotic treatment in those with both high ischaemic and bleeding risk scores. We aim to describe the distribution of these risk scores in those with a prior diagnosis of atrial fibrillation who have suffered stroke and to determine the net clinical benefit of antithrombotic treatment. Methods We used regional stroke register data in the UK. Patients with a prior diagnosis of atrial fibrillation and ischaemic or haemorrhagic stroke patients were selected and their ischaemic stroke risk score (CHA2DS2-VASc) and bleeding risk score (HEMORR2HAGES) scores retrospectively calculated. Logistic regression and Cox proportional hazards models were constructed to determine the association between antithrombotic therapy prior to stroke and in-hospital and long-term mortality. Results A total of 1928 stroke patients (mean age 81.3 years (standard deviation 8.5), 56.8% women) with prior atrial fibrillation were included. Of these, 1761 (91.3%) suffered ischaemic stroke. The most common phenotype (64%) was of those with both high CHA2DS2-VASc (≥2) and high HEMORR2HAGES score (≥4). In our fully adjusted model, patients on antithrombotic treatment with both high ischaemic and bleeding risk had a significant reduction in odds of 31% for in-hospital mortality (odds ratio 0.69 (95% confidence interval 0.48–1.00: p = 0.049)) and 17% relative risk reduction for long-term mortality (hazard ratio 0.83 (95% confidence interval 0.71–0.97: p = 0.02)). Conclusions Our study suggests that antithrombotic treatment has a prognostic benefit following incident stroke in those with both high ischaemic risk and high bleeding risk. This should be considered when choosing treatment options in this group of patients. |
| Databáze: | OpenAIRE |
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