Stroke and bleeding risk in atrial fibrillation with CHA2DS2-VASC risk score of one : the Norwegian AFNOR study
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissionsoup.com..
BACKGROUND AND AIMS: The benefit of oral anticoagulant (OAC) therapy in atrial fibrillation (AF) and intermediate stroke risk is debated. In a nationwide Norwegian cohort with a non-sex CHA2DS2-VASc risk score of one, this study aimed to investigate (i) stroke and bleeding risk in AF patients with and without OAC treatment, and (ii) the risk of stroke in non-anticoagulated individuals with and without AF.
METHODS: A total of 1 118 762 individuals including 34 460 AF patients were followed during 2011-18 until ischaemic stroke, intracranial haemorrhage, increased CHA2DS2-VASc score, or study end. One-year incidence rates (IRs) were calculated as events per 100 person-years (%/py). Cox regression models provided adjusted hazard ratios (aHRs [95% confidence intervals]).
RESULTS: Among AF patients, the ischaemic stroke IR was 0.51%/py in OAC users and 1.05%/py in non-users (aHR 0.47 [0.37-0.59]). Intracranial haemorrhage IR was 0.28%/py in OAC users and 0.19%/py in non-users (aHR 1.23 [0.88-1.72]). Oral anticoagulant use was associated with an increased risk of major bleeding (aHR 1.37 [1.16-1.63]) but lower risk of the combined outcome of ischaemic stroke, major bleeding, and mortality (aHR 0.57 [0.51-0.63]). Non-anticoagulated individuals with AF had higher risk of ischaemic stroke compared to non-AF individuals with the same risk profile (aHR 2.47 [2.17-2.81]).
CONCLUSIONS: In AF patients at intermediate risk of stroke, OAC use was associated with overall favourable clinical outcomes. Non-anticoagulated AF patients had higher risk of ischaemic stroke compared to the general population without AF with the same risk profile.
| Errataetall: |
CommentIn: Eur Heart J. 2024 Jan 1;45(1):67-69. - PMID 37995207 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:45 |
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| Enthalten in: |
European heart journal - 45(2024), 1 vom: 01. Jan., Seite 57-66 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Anjum, Mariam [VerfasserIn] |
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| Links: |
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| Themen: |
Anticoagulants |
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| Anmerkungen: |
Date Completed 02.01.2024 Date Revised 02.01.2024 published: Print CommentIn: Eur Heart J. 2024 Jan 1;45(1):67-69. - PMID 37995207 Citation Status MEDLINE |
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| doi: |
10.1093/eurheartj/ehad659 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM36486513X |
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| 245 | 1 | 0 | |a Stroke and bleeding risk in atrial fibrillation with CHA2DS2-VASC risk score of one |b the Norwegian AFNOR study |
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| 500 | |a CommentIn: Eur Heart J. 2024 Jan 1;45(1):67-69. - PMID 37995207 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissionsoup.com. | ||
| 520 | |a BACKGROUND AND AIMS: The benefit of oral anticoagulant (OAC) therapy in atrial fibrillation (AF) and intermediate stroke risk is debated. In a nationwide Norwegian cohort with a non-sex CHA2DS2-VASc risk score of one, this study aimed to investigate (i) stroke and bleeding risk in AF patients with and without OAC treatment, and (ii) the risk of stroke in non-anticoagulated individuals with and without AF | ||
| 520 | |a METHODS: A total of 1 118 762 individuals including 34 460 AF patients were followed during 2011-18 until ischaemic stroke, intracranial haemorrhage, increased CHA2DS2-VASc score, or study end. One-year incidence rates (IRs) were calculated as events per 100 person-years (%/py). Cox regression models provided adjusted hazard ratios (aHRs [95% confidence intervals]) | ||
| 520 | |a RESULTS: Among AF patients, the ischaemic stroke IR was 0.51%/py in OAC users and 1.05%/py in non-users (aHR 0.47 [0.37-0.59]). Intracranial haemorrhage IR was 0.28%/py in OAC users and 0.19%/py in non-users (aHR 1.23 [0.88-1.72]). Oral anticoagulant use was associated with an increased risk of major bleeding (aHR 1.37 [1.16-1.63]) but lower risk of the combined outcome of ischaemic stroke, major bleeding, and mortality (aHR 0.57 [0.51-0.63]). Non-anticoagulated individuals with AF had higher risk of ischaemic stroke compared to non-AF individuals with the same risk profile (aHR 2.47 [2.17-2.81]) | ||
| 520 | |a CONCLUSIONS: In AF patients at intermediate risk of stroke, OAC use was associated with overall favourable clinical outcomes. Non-anticoagulated AF patients had higher risk of ischaemic stroke compared to the general population without AF with the same risk profile | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Atrial fibrillation | |
| 650 | 4 | |a Bleeding | |
| 650 | 4 | |a Oral anticoagulation | |
| 650 | 4 | |a Prevention | |
| 650 | 4 | |a Stroke risk | |
| 650 | 7 | |a Anticoagulants |2 NLM | |
| 700 | 1 | |a Ariansen, Inger |e verfasserin |4 aut | |
| 700 | 1 | |a Hjellvik, Vidar |e verfasserin |4 aut | |
| 700 | 1 | |a Selmer, Randi |e verfasserin |4 aut | |
| 700 | 1 | |a Kjerpeseth, Lars J |e verfasserin |4 aut | |
| 700 | 1 | |a Skovlund, Eva |e verfasserin |4 aut | |
| 700 | 1 | |a Myrstad, Marius |e verfasserin |4 aut | |
| 700 | 1 | |a Ellekjær, Hanne |e verfasserin |4 aut | |
| 700 | 1 | |a Christophersen, Ingrid E |e verfasserin |4 aut | |
| 700 | 1 | |a Tveit, Arnljot |e verfasserin |4 aut | |
| 700 | 1 | |a Berge, Trygve |e verfasserin |4 aut | |
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