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The Population-Based Long-Term Impact of Anticoagulant and Antiplatelet Therapies in Low-Risk Patients With Atrial Fibrillation.
- Source :
-
The American journal of cardiology [Am J Cardiol] 2017 Jul 01; Vol. 120 (1), pp. 75-82. Date of Electronic Publication: 2017 Apr 12. - Publication Year :
- 2017
-
Abstract
- Among patients with atrial fibrillation (AF), the risk of stroke risk is a significant concern. CHADS <subscript>2</subscript> and CHA <subscript>2</subscript> DS <subscript>2</subscript> -VASc ≤2 scoring have been used to stratify patients into categories of risk. Without randomized, prospective data, the need and type of long-term antithrombotic medications for thromboembolism prevention in lower risk AF patients remains controversial. We sought to define the long-term impact of anticoagulant and antiplatelet therapy use in AF patients at low risk of stroke. A total of 56,764 patients diagnosed with AF and a CHADS <subscript>2</subscript> score of 0 or 1, or CHA <subscript>2</subscript> DS <subscript>2</subscript> -VASc score of 0, 1, or 2 were studied. Antithrombotic therapy was defined as aspirin, clopidogrel (antiplatelet therapy), or warfarin monotherapy (anticoagulation) initiated within 6 months of AF diagnosis. End points included all-cause mortality, cerebrovascular accident, transient ischemic attack (TIA), and major bleed. The average age of the population was 67.0 ± 14.1 years and 56.6% were male. In total, 9,682 received aspirin, 1,802 received clopidogrel, 1,164 received warfarin, and 46,042 did not receive any antithrombotic therapy. Event rates differed between patients with a CHADS <subscript>2</subscript> score of 0 and 1; 18.5% and 37.8% had died, 1.7% and 3.4% had a stroke, 2.2% and 3.2% had a TIA, and 14% and 12.5% had a major bleed, respectively (p <0.0001 for all). The rates of stroke, TIA, and major bleeding increased as antithrombotic therapy intensity increased from no therapy, to aspirin, to clopidogrel, and to warfarin (all p <0.0001). Similar outcomes were observed in low-risk CHA <subscript>2</subscript> DS <subscript>2</subscript> -VASc scores (0 to 2). In low-risk AF patients with a CHADS <subscript>2</subscript> score of 0 to 1 or CHA <subscript>2</subscript> DS <subscript>2</subscript> -VASc score of 0 to 2, the use of aspirin, clopidogrel, and warfarin was not associated with lower stroke rates at 5 years compared with no therapy. However, the use of antithrombotic agents was associated with a significant risk of bleed.<br /> (Copyright © 2017 Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Atrial Fibrillation complications
Atrial Fibrillation mortality
Cause of Death trends
Drug Therapy, Combination
Female
Follow-Up Studies
Hemorrhage epidemiology
Humans
Incidence
Male
Middle Aged
Prognosis
Prospective Studies
Retrospective Studies
Risk Factors
Stroke epidemiology
Stroke etiology
Survival Rate trends
Time Factors
United States epidemiology
Anticoagulants therapeutic use
Atrial Fibrillation drug therapy
Hemorrhage chemically induced
Platelet Aggregation Inhibitors therapeutic use
Risk Assessment
Stroke prevention & control
Subjects
Details
- Language :
- English
- ISSN :
- 1879-1913
- Volume :
- 120
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- The American journal of cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 28483209
- Full Text :
- https://doi.org/10.1016/j.amjcard.2017.03.256