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Antithrombotic therapy use and clinical outcomes following thrombo-embolic events in patients with atrial fibrillation : insights from ARISTOTLE

Goto, Shinya (author)
Tokai Univ, Sch Med, Dept Med Cardiol, 143 Shimokasuya, Isehara, Kanagawa 2591193, Japan.
Merrill, Peter (author)
Duke Hlth, Duke Clin Res Inst, Dept Stat, 2400 Pratt St, Durham, NC 27705 USA.
Wallentin, Lars, 1943- (author)
Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)
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Wojdyla, Daniel M. (author)
Duke Hlth, Duke Clin Res Inst, Dept Stat, 2400 Pratt St, Durham, NC 27705 USA.
Hanna, Michael (author)
Bristol Myers Squibb, 3551 Lawrenceville Princeton, Lawrence Township, NJ 08648 USA.
Avezum, Alvaro (author)
Dante Pazzanese, Inst Cardiol, Res Div, Ave Dante Pazzanese 500, BR-04012909 Sao Paulo, SP, Brazil.
Easton, J. Donald (author)
Univ Calif San Francisco, Dept Neurol, Box 0663,675 Nelson Rising Lane,412, San Francisco, CA 94158 USA.
Harjola, Veli-Pekka (author)
Univ Helsinki, Cent Hosp, Dept Med, Div Emergency Care, POB 340, Helsinki 00029, Hus, Finland.
Huber, Kurt (author)
Med Univ Vienna, Wilhelminenspital, Dept Cardiol, Spitalgasse 23, A-1090 Vienna, Austria.
Lewis, Basil S. (author)
Technion, Ruth & Bruce Rappaport Sch Med, Lady Davis Carmel Med Ctr, Dept Cardiol, Mikhal St 7, IL-3436212 Haifa, Israel.
Parkhomenko, Alexander (author)
Inst Cardiol, Dept Cardiol, Narodnoho Opolchennya St 5, UA-02000 Kiev, Ukraine.
Zhu, Jun (author)
Fuwai Hosp, Beijing, Peoples R China.
Granger, Christopher B. (author)
Duke Hlth, Duke Clin Res Inst, Dept Med, Div Cardiol, 2400 Pratt St, Durham, NC 27705 USA.
Lopes, Renato D. (author)
Duke Hlth, Duke Clin Res Inst, 2400 Pratt St, Durham, NC 27705 USA.
Alexander, John H. (author)
Duke Hlth, Duke Clin Res Inst, Dept Med, Div Cardiol, 2400 Pratt St, Durham, NC 27705 USA.
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Tokai Univ, Sch Med, Dept Med Cardiol, 143 Shimokasuya, Isehara, Kanagawa 2591193, Japan Duke Hlth, Duke Clin Res Inst, Dept Stat, 2400 Pratt St, Durham, NC 27705 USA. (creator_code:org_t)
2018-01-29
2018
English.
In: European Heart Journal - Cardiovascular Pharmacotherapy. - : Oxford University Press (OUP). - 2055-6837 .- 2055-6845. ; 4:2, s. 75-81
  • Journal article (peer-reviewed)
Abstract Subject headings
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  • Aims We investigated baseline characteristics, antithrombotic use, and clinical outcomes of patients with atrial fibrillation (AF) and a thrombo-embolic event in the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) study to better inform the care of these high-risk patients. Method and results Thrombo-embolic events were defined as stroke (ischaemic or unknown cause) or systemic embolism (SE). Clinical outcomes were estimated using the Kaplan-Meier method. All-cause mortality and International Society on Thrombosis and Haemostasis (ISTH) major bleeding after events were analysed using a Cox proportional hazards model with time-dependent covariates. Of 18 201 patients in ARISTOTLE, 365 experienced a thrombo-embolic event [337 strokes (ischaemic or unknown cause), 28 SE]; 46 (12.6%) of which were fatal. In the 30 days before and after a thrombo-embolic event, 11% and 37% of patients, respectively, were not taking an oral anticoagulant. During follow-up (median 1.8 years), 22 patients (7.1%/year) had a recurrent stroke, 97 (30.1%/year) died, and 10 (6.7%/year) had major bleeding. Compared with patients without a thrombo-embolic event, the short-and long-term adjusted hazards of death in patients with a thrombo-embolic event were high [<= 30 days: hazard ratio (HR) 54.3%, 95% confidence interval (95% CI) 41.4-71.3; >30 days: HR 3.5, 95% CI 2.5-4.8; both P<0.001]. The adjusted hazards of major bleeding were also high short-term (HR 10.37, 95% CI 3.87-27.78; P<0.001) but not long-term (HR 1.7, 95% CI: 0.77-3.88; P=0.18). Conclusions Thrombo-embolic events were rare but associated with high short-and long-term morbidity and mortality. Substantial numbers of patients are not receiving oral anticoagulattherapy before and, despite this risk, after a first thrombo-embolic event.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kardiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

Keyword

Antithrombotic therapy
Thrombo-embolic events
Atrial fibrillation

Publication and Content Type

ref (subject category)
art (subject category)

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