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Antithrombotic ther...
Antithrombotic therapy use and clinical outcomes following thrombo-embolic events in patients with atrial fibrillation : insights from ARISTOTLE
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- Goto, Shinya (author)
- Tokai Univ, Sch Med, Dept Med Cardiol, 143 Shimokasuya, Isehara, Kanagawa 2591193, Japan.
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- Merrill, Peter (author)
- Duke Hlth, Duke Clin Res Inst, Dept Stat, 2400 Pratt St, Durham, NC 27705 USA.
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- 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.
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- Hanna, Michael (author)
- Bristol Myers Squibb, 3551 Lawrenceville Princeton, Lawrence Township, NJ 08648 USA.
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- Avezum, Alvaro (author)
- Dante Pazzanese, Inst Cardiol, Res Div, Ave Dante Pazzanese 500, BR-04012909 Sao Paulo, SP, Brazil.
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- Easton, J. Donald (author)
- Univ Calif San Francisco, Dept Neurol, Box 0663,675 Nelson Rising Lane,412, San Francisco, CA 94158 USA.
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- Harjola, Veli-Pekka (author)
- Univ Helsinki, Cent Hosp, Dept Med, Div Emergency Care, POB 340, Helsinki 00029, Hus, Finland.
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- Huber, Kurt (author)
- Med Univ Vienna, Wilhelminenspital, Dept Cardiol, Spitalgasse 23, A-1090 Vienna, Austria.
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- Lewis, Basil S. (author)
- Technion, Ruth & Bruce Rappaport Sch Med, Lady Davis Carmel Med Ctr, Dept Cardiol, Mikhal St 7, IL-3436212 Haifa, Israel.
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- Parkhomenko, Alexander (author)
- Inst Cardiol, Dept Cardiol, Narodnoho Opolchennya St 5, UA-02000 Kiev, Ukraine.
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- Zhu, Jun (author)
- Fuwai Hosp, Beijing, Peoples R China.
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- Granger, Christopher B. (author)
- Duke Hlth, Duke Clin Res Inst, Dept Med, Div Cardiol, 2400 Pratt St, Durham, NC 27705 USA.
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- Lopes, Renato D. (author)
- Duke Hlth, Duke Clin Res Inst, 2400 Pratt St, Durham, NC 27705 USA.
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- 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.
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In: European Heart Journal - Cardiovascular Pharmacotherapy. - : Oxford University Press (OUP). - 2055-6837 .- 2055-6845. ; 4:2, s. 75-81
- Related links:
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https://academic.oup...
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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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- 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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Goto, Shinya
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Merrill, Peter
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Wallentin, Lars, ...
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Wojdyla, Daniel ...
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Hanna, Michael
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Avezum, Alvaro
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Easton, J. Donal ...
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Harjola, Veli-Pe ...
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Huber, Kurt
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Lewis, Basil S.
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Parkhomenko, Ale ...
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Zhu, Jun
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Granger, Christo ...
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Lopes, Renato D.
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Alexander, John ...
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- MEDICAL AND HEALTH SCIENCES
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European Heart J ...
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Uppsala University