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Oral anticoagulation therapy after stroke reduces risk for recurrent events in AF
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Patients with atrial fibrillation who received oral anticoagulation therapy after a stroke had reduced risk for recurrent thromboembolic events vs. those who received antiplatelet therapy or no antithrombotic therapy, according to a study published in JAMA Network Open.
Anna Gundlund, MD, of the cardiology department at Herlev and Gentofte Hospital in Hellerup, Denmark, and colleagues analyzed data from nationwide registries of 30,626 patients with AF who were admitted to a hospital for ischemic stroke from 2004 to January 2017. Men with a CHA2DS2-VASc score of at least 1 and women with a CHA2DS2-VASc score of at least 2 were included.
Researchers also identified patients who had a stroke and survived 100 days after hospital discharge. Patients were categorized by poststroke antithrombotic therapy: oral anticoagulation therapy (n = 11,139; median age, 79 years; 44% women), antiplatelet therapy alone (n = 11,874; median age, 82 years; 55% women) and no antithrombotic therapy (n = 7,613; median age, 80 years; 54% women).
The outcomes of interest were bleeding events, death and thromboembolic events, including unspecific stroke, ischemic stroke, transient ischemic attack and either thrombosis or embolism in peripheral arteries. Follow-up was conducted until June 30, 2017.
After the stroke, 43.7% of patients who received no antithrombotic therapy before the stroke and 31.3% of those who received antiplatelet therapy alone shifted to oral anticoagulation therapy, although 37.5% of patients who had a stroke did not receive oral anticoagulation afterward. The percentage of patients who received oral anticoagulation therapy increased from 36.3% before the stroke to 52.5% after the stroke.
During up to 10 years of follow-up, a new thromboembolic event occurred in 17.5% of patients treated with oral anticoagulation therapy, 21.2% of those treated with antiplatelet therapy and 21.5% of patients who did not receive therapy. Mortality rates during the follow-up period were 72.7% in patients taking oral anticoagulation therapy, 86.4% in patients taking antiplatelet therapy and 86.2% in patients taking no antithrombotic therapy.
Compared with patients who did not receive antithrombotic therapy after stroke, those treated with oral anticoagulation therapy after stroke had a lower risk for recurrent thromboembolic events (adjusted HR = 0.81; 95% CI, 0.73-0.89). There was no significant difference between the two groups regarding bleeding complications (aHR= 0.97; 95% CI, 0.86-1.1).
The antiplatelet therapy group and the no antithrombotic therapy group had no significant differences for thromboembolic events (aHR = 1.01; 95% CI, 0.92-1.12) and death (aHR = 0.95; 95% CI, 0.91-1).
“Taken together, these findings suggest substantial opportunities for improvement of both primary and secondary stroke prevention in intermediate- to high-risk patients with AF,” Gundlund and colleagues wrote. – by Darlene Dobkowski
Disclosures: Gundlund reports she received research funding from Bristol-Myers Squibb. Please see the study for all other authors’ relevant financial disclosures.
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