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Risks associated with discontinuation of oral anticoagulation in newly diagnosed patients with atrial fibrillation: Results from the GARFIELD-AF Registry.

Cools, F; Johnson, D; Camm, AJ; Bassand, J-P; Verheugt, FWA; Yang, S; Tsiatis, A; Fitzmaurice, DA; Goldhaber, SZ; Kayani, G; et al. Cools, F; Johnson, D; Camm, AJ; Bassand, J-P; Verheugt, FWA; Yang, S; Tsiatis, A; Fitzmaurice, DA; Goldhaber, SZ; Kayani, G; Goto, S; Haas, S; Misselwitz, F; Turpie, AGG; Fox, KAA; Pieper, KS; Kakkar, AK; GARFIELD-AF Investigators (2021) Risks associated with discontinuation of oral anticoagulation in newly diagnosed patients with atrial fibrillation: Results from the GARFIELD-AF Registry. J Thromb Haemost, 19 (9). pp. 2322-2334. ISSN 1538-7836 https://doi.org/10.1111/jth.15415
SGUL Authors: Camm, Alan John

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Abstract

BACKGROUND: Oral anticoagulation (OAC) in atrial fibrillation (AF) reduces the risk of stroke/systemic embolism (SE). The impact of OAC discontinuation is less well documented. OBJECTIVE: Investigate outcomes of patients prospectively enrolled in GARFIELD-AF who discontinued OAC. METHODS: OAC discontinuation was defined as cessation of treatment for ≥7 consecutive days. Adjusted outcome risks were assessed in 23,882 patients with 511 days of median follow-up after discontinuation. RESULTS AND CONCLUSIONS: Patients who discontinued (n=3,114, 13.0%) had a higher risk (Hazard ratio [95% CI]) of all-cause death (1.62 [1.25-2.09]), stroke/systemic embolism (SE) (2.21 [1.42-3.44]) and myocardial infarction (MI) (1.85 [1.09-3.13]) than patients who did not, whether OAC was restarted or not. This higher risk of outcomes after discontinuation was similar for patients treated with vitamin K antagonists (VKA) and direct oral anticoagulants (DOACs) (p for interactions range=0.145-0.778). Bleeding history (1.43 [1.14-1.80]), paroxysmal vs. persistent AF (1.15 [1.02-1.29]), emergency room care setting vs. office (1.37 [1.18-1.59]), major, clinically relevant non-major, and minor bleeding (10.02 [7.19-13.98], 2.70 [2.24-3.25] and 1.90 [1.61-2.23]), stroke/SE (4.09 [2.55-6.56]), MI (2.74 [1.69-4.43]), and left atrial appendage procedures (4.99 [1.82-13.70]) were predictors of discontinuation. Age (0.84 [0.81-0.88], per 10-year increase), history of stroke/TIA (0.81 [0.71-0.93]), diabetes (0.88 [0.80-0.97]), weeks from AF onset to treatment (0.96 [0.93-0.99] per week), and permanent vs. persistent AF (0.73 [0.63-0.86]) were predictors of lower discontinuation rates. Discontinuation for ≥7 consecutive days was associated with significantly higher all-cause mortality, stroke/SE and MI risk. Caution should be exerted when considering any OAC discontinuation beyond 7 days.

Item Type: Article
Additional Information: © 2021 The Authors. Journal of Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Keywords: Anticoagulation, antiplatelet, atrial fibrillation, discontinuation, marginal structure models, outcomes, GARFIELD-AF Investigators, Cardiovascular System & Hematology, 1102 Cardiorespiratory Medicine and Haematology, 1103 Clinical Sciences
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: J Thromb Haemost
ISSN: 1538-7836
Language: eng
Dates:
DateEvent
25 August 2021Published
23 July 2021Published Online
19 May 2021Accepted
Publisher License: Creative Commons: Attribution-Noncommercial 4.0
Projects:
Project IDFunderFunder ID
T32 HL079896NHLBI NIH HHSUNSPECIFIED
PubMed ID: 34060704
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/113357
Publisher's version: https://doi.org/10.1111/jth.15415

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