Does prior antithrombotic therapy influence stroke recurrence and bleeding risk in patients with atrial fibrillation and flutter?

David T. Gamble (Corresponding Author), Romain Buono, Mamas A. Mamas, Stephen Leslie, Joao H. Bettencourt-Silva, Allan B. Clark, Kristian M. Bowles, Anthony Kneale Metcalf, John F. Potter, Phyo K Myint

Research output: Contribution to journalArticle

1 Citation (Scopus)
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Abstract

Background
Whilst antithrombotic therapy is recommended in people with atrial fibrillation, little is known about the survival benefits of antithrombotic treatment in those with both high ischaemic and bleeding risk scores. We aim to describe the distribution of these risk scores in those with a prior diagnosis of atrial fibrillation who have suffered stroke and to determine the net clinical benefit of antithrombotic treatment.

Methods
We used regional stroke register data in the UK. Patients with a prior diagnosis of atrial fibrillation and ischaemic or haemorrhagic stroke patients were selected and their ischaemic stroke risk score (CHA2DS2-VASc) and bleeding risk score (HEMORR2HAGES) scores retrospectively calculated. Logistic regression and Cox proportional hazards models were constructed to determine the association between antithrombotic therapy prior to stroke and in-hospital and long-term mortality.

Results
A total of 1928 stroke patients (mean age 81.3 years (standard deviation 8.5), 56.8% women) with prior atrial fibrillation were included. Of these, 1761 (91.3%) suffered ischaemic stroke. The most common phenotype (64%) was of those with both high CHA2DS2-VASc (≥2) and high HEMORR2HAGES score (≥4). In our fully adjusted model, patients on antithrombotic treatment with both high ischaemic and bleeding risk had a significant reduction in odds of 31% for in-hospital mortality (odds ratio 0.69 (95% confidence interval 0.48–1.00: p = 0.049)) and 17% relative risk reduction for long-term mortality (hazard ratio 0.83 (95% confidence interval 0.71–0.97: p = 0.02)).

Conclusions
Our study suggests that antithrombotic treatment has a prognostic benefit following incident stroke in those with both high ischaemic risk and high bleeding risk. This should be considered when choosing treatment options in this group of patients.
Original languageEnglish
Pages (from-to)729-737
Number of pages9
JournalEuropean Journal of Preventive Cardiology
Volume27
Issue number7
Early online date3 Sep 2019
DOIs
Publication statusPublished - 1 May 2020

Keywords

  • stroke
  • atrial fibrillation
  • thromboprophylaxis
  • antithrombotic treatment
  • MORTALITY
  • Stroke
  • MANAGEMENT
  • HEMORRHAGE
  • SCORES
  • PREVENTION
  • OUTCOMES
  • PREDICTION

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