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  • Goto, ShinyaTokai Univ, Sch Med, Dept Med Cardiol, 143 Shimokasuya, Isehara, Kanagawa 2591193, Japan. (author)

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

  • Article/chapterEnglish2018

Publisher, publication year, extent ...

  • 2018-01-29
  • Oxford University Press (OUP),2018
  • printrdacarrier

Numbers

  • LIBRIS-ID:oai:DiVA.org:uu-351634
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-351634URI
  • https://doi.org/10.1093/ehjcvp/pvy002DOI

Supplementary language notes

  • Language:English
  • Summary in:English

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  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

Notes

  • 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 and genre

Added entries (persons, corporate bodies, meetings, titles ...)

  • Merrill, PeterDuke Hlth, Duke Clin Res Inst, Dept Stat, 2400 Pratt St, Durham, NC 27705 USA. (author)
  • Wallentin, Lars,1943-Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)(Swepub:uu)larswall (author)
  • Wojdyla, Daniel M.Duke Hlth, Duke Clin Res Inst, Dept Stat, 2400 Pratt St, Durham, NC 27705 USA. (author)
  • Hanna, MichaelBristol Myers Squibb, 3551 Lawrenceville Princeton, Lawrence Township, NJ 08648 USA. (author)
  • Avezum, AlvaroDante Pazzanese, Inst Cardiol, Res Div, Ave Dante Pazzanese 500, BR-04012909 Sao Paulo, SP, Brazil. (author)
  • Easton, J. DonaldUniv Calif San Francisco, Dept Neurol, Box 0663,675 Nelson Rising Lane,412, San Francisco, CA 94158 USA. (author)
  • Harjola, Veli-PekkaUniv Helsinki, Cent Hosp, Dept Med, Div Emergency Care, POB 340, Helsinki 00029, Hus, Finland. (author)
  • Huber, KurtMed Univ Vienna, Wilhelminenspital, Dept Cardiol, Spitalgasse 23, A-1090 Vienna, Austria. (author)
  • Lewis, Basil S.Technion, Ruth & Bruce Rappaport Sch Med, Lady Davis Carmel Med Ctr, Dept Cardiol, Mikhal St 7, IL-3436212 Haifa, Israel. (author)
  • Parkhomenko, AlexanderInst Cardiol, Dept Cardiol, Narodnoho Opolchennya St 5, UA-02000 Kiev, Ukraine. (author)
  • Zhu, JunFuwai Hosp, Beijing, Peoples R China. (author)
  • Granger, Christopher B.Duke Hlth, Duke Clin Res Inst, Dept Med, Div Cardiol, 2400 Pratt St, Durham, NC 27705 USA. (author)
  • Lopes, Renato D.Duke Hlth, Duke Clin Res Inst, 2400 Pratt St, Durham, NC 27705 USA. (author)
  • Alexander, John H.Duke Hlth, Duke Clin Res Inst, Dept Med, Div Cardiol, 2400 Pratt St, Durham, NC 27705 USA. (author)
  • 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)

Related titles

  • In:European Heart Journal - Cardiovascular Pharmacotherapy: Oxford University Press (OUP)4:2, s. 75-812055-68372055-6845

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