Thromboembolic and haemorrhagic events in patients with atrial fibrillation: a prospective cohort study in UK primary and secondary care.
Aged
Aged, 80 and over
Anticoagulants
/ therapeutic use
Atrial Fibrillation
/ complications
Brain Ischemia
/ epidemiology
Cohort Studies
Female
Gastrointestinal Hemorrhage
/ epidemiology
Humans
Male
Middle Aged
Platelet Aggregation Inhibitors
/ therapeutic use
Primary Health Care
Proportional Hazards Models
Secondary Care
Stroke
/ epidemiology
Thromboembolism
/ epidemiology
United Kingdom
anticoagulants
atrial fibrillation
gastrointestinal haemorrhage
myocardial ischaemia
primary health care
stroke
Journal
The British journal of general practice : the journal of the Royal College of General Practitioners
ISSN: 1478-5242
Titre abrégé: Br J Gen Pract
Pays: England
ID NLM: 9005323
Informations de publication
Date de publication:
Jun 2019
Jun 2019
Historique:
received:
18
09
2018
accepted:
29
11
2018
pubmed:
25
4
2019
medline:
2
1
2020
entrez:
25
4
2019
Statut:
ppublish
Résumé
Strong evidence on the long-term safety and efficacy of different types of anticoagulants would help clinicians to prevent thromboembolic events among patients with atrial fibrillation (AF) while minimising the risk of haemorrhages. To estimate the risk of thromboembolic and haemorrhagic events for patients with AF on antiplatelets or anticoagulants. This was a cohort study using routinely collected UK primary and secondary care clinical data from patients with AF, aged ≥18 years, and with an indication to receive anticoagulation before April 2012. The risk of ischaemic stroke or transient ischaemic attack (TIA), coronary heart disease (CHD), peripheral artery disease (PAD), or gastrointestinal (GI) haemorrhage, between 1 April 2012 and 1 April 2017, was estimated using multivariate Cox regression models for patients on antiplatelets only, a combination of antiplatelets and vitamin K antagonists (VKAs), or novel oral anticoagulants (NOACs), and compared with those on VKAs only. Compared with VKAs, antiplatelets were associated with a higher risk of stroke or TIA, hazard ratio (HR) 1.51, 95% confidence interval (CI) = 1.09 to 2.09, and GI haemorrhage, HR 1.79, 95% CI = 1.01 to 3.18. The risk of thromboembolic and haemorrhagic events was similar for those on a combination of antiplatelets and VKAs, or those on VKAs only. The risk was also similar for those on NOACs or VKAs, except for CHD, where it was higher for patients on NOACs, HR 2.07, 95% CI = 1.35 to 3.19. Anticoagulants are associated with lower risk of thromboembolic and haemorrhagic events among patients with AF than antiplatelets. More research is required on the risk associated with VKAs or NOACs.
Sections du résumé
BACKGROUND
BACKGROUND
Strong evidence on the long-term safety and efficacy of different types of anticoagulants would help clinicians to prevent thromboembolic events among patients with atrial fibrillation (AF) while minimising the risk of haemorrhages.
AIM
OBJECTIVE
To estimate the risk of thromboembolic and haemorrhagic events for patients with AF on antiplatelets or anticoagulants.
DESIGN AND SETTING
METHODS
This was a cohort study using routinely collected UK primary and secondary care clinical data from patients with AF, aged ≥18 years, and with an indication to receive anticoagulation before April 2012.
METHOD
METHODS
The risk of ischaemic stroke or transient ischaemic attack (TIA), coronary heart disease (CHD), peripheral artery disease (PAD), or gastrointestinal (GI) haemorrhage, between 1 April 2012 and 1 April 2017, was estimated using multivariate Cox regression models for patients on antiplatelets only, a combination of antiplatelets and vitamin K antagonists (VKAs), or novel oral anticoagulants (NOACs), and compared with those on VKAs only.
RESULTS
RESULTS
Compared with VKAs, antiplatelets were associated with a higher risk of stroke or TIA, hazard ratio (HR) 1.51, 95% confidence interval (CI) = 1.09 to 2.09, and GI haemorrhage, HR 1.79, 95% CI = 1.01 to 3.18. The risk of thromboembolic and haemorrhagic events was similar for those on a combination of antiplatelets and VKAs, or those on VKAs only. The risk was also similar for those on NOACs or VKAs, except for CHD, where it was higher for patients on NOACs, HR 2.07, 95% CI = 1.35 to 3.19.
CONCLUSION
CONCLUSIONS
Anticoagulants are associated with lower risk of thromboembolic and haemorrhagic events among patients with AF than antiplatelets. More research is required on the risk associated with VKAs or NOACs.
Identifiants
pubmed: 31015222
pii: bjgp19X702269
doi: 10.3399/bjgp19X702269
pmc: PMC6532794
doi:
Substances chimiques
Anticoagulants
0
Platelet Aggregation Inhibitors
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e407-e412Informations de copyright
© British Journal of General Practice 2019.
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