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Stroke risk with oral anticoagulants

Stroke rates are higher on oral anticoagulants (OACs) with some patient clinical characteristics, which could potentially be used to consider a risk assessment tool to flag up high-risk patients while on an OAC, according to a study1 published recently in Stroke.

The authors identified contemporary clinical trials that investigated OACs in patients with atrial fibrillation (AF). Event rates per year from each study and pooled event rates and relative risks, all with a 95% confidence interval, were calculated. Statistical heterogeneity was assessed using the I2 test.

Six trials were included in the meta-analysis, with a total of 58,883 patients randomised. Characteristics associated with a higher relative risk of stroke while on an OAC included age ≥75 years (relative risk, 1.46), female sex (1.30), previous stroke/transient ischaemic attack (1.85), vitamin K-antagonist naive status (for vitamin K antagonist experienced, 0.85), moderate and severe renal impairment (1.54 and 2.22, respectively, compared with normal renal function), previous aspirin use (1.19), Asian race (1.70), and a CHADS2 score of ≥3 (1.64).

It is uncertain whether these risk factors apply to novel OACs, say the authors.

References

1. Albertsen IE, Rasmussen LH, Overvad TF, et al. Risk of stroke or systemic embolism in atrial fibrillation patients treated with warfarin a systematic review and meta-analysis. Stroke 2013. http://dx.doi.org/10.1161/​STROKEAHA.113.000883

Published on: March 27, 2013

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ENDORSED BY

  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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