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Clinical Summary

Atrial Fibrillation: Stroke Risk Higher with Oral Anticoagulant Discontinuation

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.
 

García Rodríguez LA, Cea Soriano L, Munk Hald S, Hallas J, Balabanova Y, Brobert G, Vora P, Sharma M, Gaist D. Discontinuation of oral anticoagulation in atrial fibrillation and risk of ischaemic stroke. Heart. 2020 Dec 11 [Epub ahead of print]. doi: 10.1136/heartjnl-2020-317887. PMID: 33310887View full text

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.

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