Abstract
This study sought to determine how many patients with atrial fibrillation (AF) are not treated with oral anticoagulants (OAC) due to a high risk of bleeding and to characterize their risk of ischemic stroke in a real-world setting. AF is associated with a 5-fold increased risk of ischemic stroke. OAC reduce the risk of stroke in patients with AF who do not have an increased bleeding risk, but no comparably effective treatment exists for patients with contraindications to OAC. We analyzed administrative claims data from individuals with commercial and Medicare supplemental health insurance in the United States. We selected patients with AF and a documented contraindication to OAC who were not treated with OAC. The primary endpoint was the occurrence of ischemic stroke, as calculated per patient year. We identified 1,300,643 patients with AF claims, of which 43,248 had a contraindication event and remained OAC naive for at least 1 year or died in hospital. More than 80% of the patients had a CHA2DS2-VASc score of >1. The incidence of ischemic stroke was 4.1% in the overall OAC naive cohort and was more common with increasing CHA2DS2/CHA2DS2-VASc score. Hemorrhagic stroke occurred in 3.6%. For patients with previous intracranial b...Continue Reading
References
May 10, 2001·JAMA : the Journal of the American Medical Association·A S GoD E Singer
Jun 13, 2001·JAMA : the Journal of the American Medical Association·B F GageM J Radford
Aug 18, 2004·Circulation·Donald M Lloyd-JonesEmelia J Benjamin
May 23, 2007·Circulation·Elaine M HylekSusan Regan
Jun 20, 2007·Annals of Internal Medicine·Robert G HartMaria I Aguilar
Sep 24, 2008·Neurocritical Care·Joshua N GoldsteinJonathan Rosand
Sep 1, 2009·The New England Journal of Medicine·Stuart J ConnollyUNKNOWN RE-LY Steering Committee and Investigators
Oct 23, 2010·Stroke; a Journal of Cerebral Circulation·Gregory Y H LipDeirdre A Lane
Aug 13, 2011·The New England Journal of Medicine·Manesh R PatelUNKNOWN ROCKET AF Investigators
Aug 30, 2011·The New England Journal of Medicine·Christopher B GrangerUNKNOWN ARISTOTLE Committees and Investigators
Dec 15, 2011·Lancet·Gregory Y H LipDeirdre A Lane
Jan 17, 2012·European Heart Journal·Leif FribergGregory Y H Lip
Aug 28, 2012·European Heart Journal·A John CammUNKNOWN ESC Committee for Practice Guidelines (CPG)
Sep 24, 2013·Journal of the American College of Cardiology·Vanessa RoldánGregory Y H Lip
Nov 21, 2013·The New England Journal of Medicine·Robert P GiuglianoUNKNOWN ENGAGE AF-TIMI 48 Investigators
Dec 10, 2013·Lancet·Christian T RuffElliott M Antman
Apr 2, 2014·Journal of the American College of Cardiology·Craig T JanuaryClyde W Yancy
Nov 21, 2014·Chest·Peter Brønnum NielsenGregory Y H Lip
Citations
Jun 20, 2018·American Journal of Cardiovascular Drugs : Drugs, Devices, and Other Interventions·Ayesha AtherVincent Y See
Aug 7, 2019·Journal of Atrial Fibrillation·Kareem BedeirBasel Ramlawi
Jul 14, 2020·Expert Opinion on Pharmacotherapy·José Miguel Rivera-CaravacaFrancisco Marín
Oct 2, 2020·Journal of Thrombosis and Thrombolysis·Gregory PiazzaSamuel Z Goldhaber
Oct 30, 2018·Journal of the American Heart Association·Marissa K Edmiston, William R Lewis
Aug 5, 2018·Blood Reviews·Benjamin F TillmanDavid Gailani
Oct 12, 2021·Current Medical Research and Opinion·Matthew SussmanManuela Di Fusco
Dec 11, 2021·Expert Review of Medical Devices·Mingzhong ZhaoJiangtao Yu