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Impact of oral anticoagulation in patients with atrial fibrillation at very low thromboembolic risk.

Verbrugge, FH; Martin, A-C; Siegal, D; Pieper, K; Illingworth, L; Camm, AJ; Fox, KAA (2020) Impact of oral anticoagulation in patients with atrial fibrillation at very low thromboembolic risk. Heart, 106 (11). pp. 845-851. ISSN 1468-201X https://doi.org/10.1136/heartjnl-2019-315873
SGUL Authors: Camm, Alan John

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Abstract

OBJECTIVE: To investigate reasons for and impact of oral anticoagulation (OAC) in patients with atrial fibrillation (AF) at very low thromboembolic risk. METHODS: Individuals with CHA2DS2-VASc score 0 (men) or 1 (women) from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) were studied. Baseline characteristics according to OAC use were evaluated by logistic regression analysis. Non-haemorrhagic stroke or systemic embolism, major bleeding, cardiovascular and all-cause mortality were compared. RESULTS: From 2224 low CHA2DS2-VASc patients in GARFIELD-AF, 44% received OAC. In an adjusted model, increasing age up to 65 years (OR (95% CI)=1.31 (1.19 to 1.44)) and persistent AF (OR (95% CI)=3.25 (2.44 to 4.34)) or permanent AF (OR (95% CI)=2.29 (1.59 to 3.30)) versus paroxysmal/unclassified AF were associated with OAC use. Concomitant antiplatelet therapy (OR (95% CI)=0.21 (0.17 to 0.27)) was inversely associated. Crude incidence rates per 100 person-years over 2 years in patients on OAC versus not on OAC were 0.32 (95% CI 0.14 to 0.71) vs 0.30 (95% CI 0.14 to 0.63) for non-haemorrhagic stroke or systemic embolism, 0.21 (95% CI 0.08 to 0.57) vs 0.17 (95% CI 0.06 to 0.46) for major bleeding, 0.26 (95% CI 0.11 to 0.64) vs 0.26 (95% CI 0.12 to 0.57) for cardiovascular mortality and 0.74 (95% CI 0.44 to 1.25) vs 0.99 (95% CI 0.66 to 1.49) for all-cause mortality. CONCLUSIONS: In contrast to guideline recommendations, almost half of real-world patients with AF at a very low thromboembolic risk according to the CHA2DS2-VASc score receive OAC. Persistent or permanent AF and increasing age up to 65 years are associated with OAC use, while concomitant antiplatelet therapy shows an inverse association. Regardless whether patients received OAC therapy, few thromboembolic and bleeding events occur, highlighting the low risk of this population.

Item Type: Article
Additional Information: This article has been accepted for publication in Heart, 2019 following peer review, and the Version of Record can be accessed online at http://dx.doi.org/10.1136/heartjnl-2019-315873. © Author(s) (or their employer(s)) 2019.
Keywords: atrial fibrillation, neurologic events, stroke, Cardiovascular System & Hematology, 1102 Cardiorespiratory Medicine and Haematology
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Heart
ISSN: 1468-201X
Language: eng
Dates:
DateEvent
12 May 2020Published
5 December 2019Published Online
3 November 2019Accepted
Publisher License: Publisher's own licence
PubMed ID: 31806700
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/111478
Publisher's version: https://doi.org/10.1136/heartjnl-2019-315873

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