Takeaway
- Patients with atrial fibrillation (AF) who discontinue oral anticoagulant (OAC) therapy have a 2- to 3-fold increased risk of ischaemic stroke (IS) than those who maintain therapy, irrespective of OAC class, time since discontinuation or duration of OAC use.
Why this matters
- Encouraging persistence with OAC therapy in patients with AF could potentially reduce IS events that are attributed to AF.
Study design
- This population-based cohort study with nested case-control analysis included patients with AF using data from IQVIA Medical Research Data-UK (IMRD-UK; n=76,882) and linked registries from the Region of Southern Denmark (RSD; n=41,526).
- Patients with AF were followed to identify incident IS cases during 2016-2018.
- Incident IS cases were matched by age and sex to control participants.
- Funding: Bayer AG.
Key results
- Overall, 616 and 643 incidents IS cases were identified in IMRD-UK and RSD, respectively.
- For any OAC discontinuation, the adjusted ORs (aORs) were:
- 2.99 (95% CI, 2.31-3.86, IMRD-UK); and
- 2.30 (95% CI, 1.79-2.95, RSD).
- For vitamin K antagonist discontinuation, the aORs were:
- 2.38 (95% CI, 1.72-3.30, IMRD-UK); and
- 1.83 (95% CI, 1.34-2.48, RSD).
- For non-vitamin K antagonist discontinuation, the aORs were:
- 4.59 (95% CI, 2.97-7.08, IMRD-UK); and
- 3.37 (95% CI, 2.35-4.84, RSD).
- These ORs were not affected by time since OAC discontinuation, duration of OAC use or OAC class.
Limitations
- Risk of misclassification of OAC exposure.
This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.