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Stopping oral anticoagulation increases stroke risk

Oral anticoagulation (OAC) is highly effective in reducing thromboembolism and mortality in atrial fibrillation (AF) and stopping OAC significantly increases risk of stroke and mortality. This is the principal finding from a study conducted by Dr Jose Miguel Rivera-Caravaca (Hospital Universitario Virgen de la Arrixaca, Murcia, Spain) and co-workers.1

They analysed the rate of cessation of OACs in a large ‘real world’ cohort of AF patients, and its prognostic implications. They recruited 1,312 consecutive patients with permanent/paroxysmal AF from an anticoagulation clinic, who were clinically stable on an OAC for at least six months (48% male, median age 76 years; median CHA2DS2-VASc score of 4; median HASBLED score of 2). Adverse cardiovascular end points were defined as stroke/transient ischemic attack, as well as both systemic embolism, acute coronary syndrome, acute heart failure and cardiac death. They assessed bleeding events and recorded those patients with OAC cessation.

After median follow up of 2,372 days, 127 patients (1.4% per year) suffered an ischaemic/embolic stroke and 543 (6.3% per year) died (81 cardiovascular

deaths), whilst 240 (2.8% per year) had a major bleeding event. OAC cessation occurred in 131 (1.5% per year; of these, 81 received aspirin, 21 low molecular weight heparin [LMWH] and 29 no antithrombotic therapy).

Cessation of OAC was significantly associated with a higher risk of stroke (Cox regression analysis, adjusted by CHA2DS2-VASc score, hazard ratio [HR] 1.87 p=0.009) and death (HR 1.44; p=0.004).  The variables associated with OAC cessation were identified as:

  • HASBLED score ≥3
  • Major haemorrhagic event during follow up
  • Cancer during follow up
  • Renal impairment during follow up
  • Age >80 years at entry.

Reference

1. Rivera-Caravaca JM et al. Cessation of oral anticoagulation is an important risk factor for stroke and mortality in atrial fibrillation patients. Abstract P6442. Eur Heart J 2016;37 (Abstract supplement):1247-8.

Published on: October 19, 2016

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ENDORSED BY

  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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