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Clinical Outcomes and History of Fall in Patients with Atrial Fibrillation Treated with Oral Anticoagulation : Insights From the ARISTOTLE Trial
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Rao, Meena P (author)
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Vinereanu, Dragos (author)
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Wojdyla, Daniel M (author)
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Alexander, John H (author)
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Atar, Dan (author)
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Hylek, Elaine M (author)
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Hanna, Michael (author)
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- Wallentin, Lars, 1943- (author)
- Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),UCR
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Lopes, Renato D (author)
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Gersh, Bernard J (author)
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Granger, Christopher B (author)
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(creator_code:org_t)
- Elsevier BV, 2018
- 2018
- English.
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In: American Journal of Medicine. - : Elsevier BV. - 0002-9343 .- 1555-7162. ; 131:3, s. 269-275.e2
- Related links:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
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- PURPOSE: We assessed outcomes among anticoagulated patients with atrial fibrillation and a history of falling, and whether the benefits of apixaban vs warfarin are consistent in this population.METHODS: Of the 18,201 patients in the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) study, 16,491 had information about history of falling-753 with history of falling and 15,738 without history of falling. The primary efficacy outcome was stroke or systemic embolism; the primary safety outcome was major bleeding.RESULTS: -VASc (Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, prior Stroke or TIA or thromboembolism, Vascular disease, Age 65-74 years, Sex category female) and HAS-BLED (Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile international normalized ratio, Elderly, Drugs or alcohol) scores. Patients with a history of falling had higher rates of major bleeding (adjusted hazard ratio [HR] 1.39; 95% confidence interval [CI], 1.05-1.84; P = .020), including intracranial bleeding (adjusted HR 1.87; 95% CI, 1.02-3.43; P = .044) and death (adjusted HR 1.70; 95% CI, 1.36-2.14; P < .0001), but similar rates of stroke or systemic embolism and hemorrhagic stroke. There was no evidence of a differential effect of apixaban compared with warfarin on any outcome, regardless of history of falling. Among those with a history of falling, subdural bleeding occurred in 5 of 367 patients treated with warfarin and 0 of 386 treated with apixaban.CONCLUSIONS: Patients with atrial fibrillation and a history of falling receiving anticoagulation have a higher risk of major bleeding, including intracranial, and death. The efficacy and safety of apixaban compared with warfarin were consistent, irrespective of history of falling.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Allmänmedicin (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- General Practice (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Keyword
- Anticoagulation
- Apixaban
- Atrial fibrillation
- Bleeding
- History of falls
- Stroke
- Warfarin
Publication and Content Type
- ref (subject category)
- art (subject category)
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Rao, Meena P
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Vinereanu, Drago ...
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Wojdyla, Daniel ...
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Alexander, John ...
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Atar, Dan
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Hylek, Elaine M
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Hanna, Michael
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Wallentin, Lars, ...
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Lopes, Renato D
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Gersh, Bernard J
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Granger, Christo ...
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and General Practice
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MEDICAL AND HEAL ...
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Uppsala University