Abstract
There is growing interest in the role for non-vitamin K antagonist oral anticoagulants (NOACs) in patients without atrial fibrillation (AF). We aimed to provide a comprehensive assessment of the risks of ischemic stroke, myocardial infarction (MI), AF, and major bleeding in patients without previously diagnosed AF. Using a large US administrative database, we identified 6,495,875 patients ≥50 years between January 1, 2011, and September 30, 2016, who were not diagnosed with AF and were not treated with oral anticoagulants or nonaspirin antiplatelet agents. We assessed the risks by age, sex, the number of risk factors, and the combination of risk factors. We also calculated the number needed to treat or harm based on the untreated risks in our data set and relative risks of NOAC treatment derived from a recent clinical trial. The event rates were 0.67%/y for ischemic stroke or MI, 0.96%/y for AF, and 0.52%/y for major bleeding. Among patients who had a stroke during follow-up, 84% were not diagnosed with AF at any time, and only 5% were diagnosed with AF before the stroke. Patients who had low number needed to treat for cardiovascular risk reduction (ie, potentially benefiting the most from the addition of NOACs) also had low nu...Continue Reading
References
Dec 3, 1999·BMJ : British Medical Journal·D G Altman, P K Andersen
Oct 5, 2002·Stroke; a Journal of Cerebral Circulation·David L Tirschwell, W T Longstreth
Apr 28, 2004·Archives of Internal Medicine·Jonathan RosandSteven M Greenberg
May 6, 2004·Journal of Clinical Epidemiology·Machelle WilcheskyAllen Huang
Jan 8, 2005·Stroke; a Journal of Cerebral Circulation·Paul S J MillerLalit Kalra
Mar 17, 2010·Lancet·Peter M Rothwell
May 22, 2010·BMJ : British Medical Journal·Julia Hippisley-Cox, Carol Coupland
Mar 10, 2011·Pharmacoepidemiology and Drug Safety·Andrew CunninghamWayne A Ray
Apr 12, 2012·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Russell C DavisMichael K Davies
May 23, 2012·Lancet·UNKNOWN Cholesterol Treatment Trialists' (CTT) CollaboratorsC Baigent
Dec 6, 2012·Health Affairs·J Michael McWilliamsJoseph P Newhouse
Nov 28, 2013·European Heart Journal·Jonathan P PicciniSusan R Heckbert
May 3, 2014·Stroke; a Journal of Cerebral Circulation·Walter N KernanUNKNOWN American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and
Jul 10, 2014·Health Affairs·Paul J WallaceWilliam H Crown
Oct 31, 2014·Stroke; a Journal of Cerebral Circulation·James F MeschiaUNKNOWN Council on Hypertension
Apr 18, 2015·Journal of the American College of Cardiology·Sripal BangaloreUNKNOWN TNT Steering Committee and Investigators
Jul 25, 2015·Journal of the American Heart Association·Janice Y ChyouMatthew R Reynolds
Sep 1, 2015·JAMA : the Journal of the American Medical Association·Line MelgaardGregory Y H Lip
Oct 1, 2015·International Journal of Stroke : Official Journal of the International Stroke Society·Hans-Christoph DienerUNKNOWN RE-SPECT ESUS Investigators
Mar 26, 2016·The American Journal of Medicine·Walid SalibaGad Rennert
Apr 12, 2016·Annals of Internal Medicine·Evelyn P WhitlockCorinne V Evans
Apr 12, 2016·Annals of Internal Medicine·Janelle M Guirguis-BlakeEvelyn P Whitlock
Nov 4, 2016·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Paulus KirchhofKatja Zeppenfeld
Dec 3, 2016·Journal of the American College of Cardiology·Jennifer G RobinsonMichael J Pencina
Aug 29, 2017·The New England Journal of Medicine·John W EikelboomUNKNOWN COMPASS Investigators
Sep 1, 2016·European Stroke Journal·Robert G HartStuart J Connolly