Anticoagulation therapy in atrial fibrillation after intracranial hemorrhage
Background The effect of oral anticoagulation therapy (OAT) in patients with atrial fibrillation (AF) with a history of intracranial hemorrhage (ICH) is poorly defined. Objective The purpose of this study was to evaluate the efficacy and safety of OAT in patients with AF with an ICH history. Methods...
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| Veröffentlicht in: | Heart rhythm 2016-09, Vol.13 (9), p.1794-1802 |
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| creator | Park, Young-Ah, MD Uhm, Jae-Sun, MD Pak, Hui-Nam, MD, PhD Lee, Moon-Hyoung, MD, PhD Joung, Boyoung, MD, PhD |
| description | Background The effect of oral anticoagulation therapy (OAT) in patients with atrial fibrillation (AF) with a history of intracranial hemorrhage (ICH) is poorly defined. Objective The purpose of this study was to evaluate the efficacy and safety of OAT in patients with AF with an ICH history. Methods We retrospectively compared the composite end point, including thromboembolic and major bleeding events, between patients with AF with a history of ICH who were (OAT group, n = 254) and those who were not (no-OAT group, n = 174) taking OAT. Results During a mean follow-up of 39.5 ± 31.9 months, 5.5 and 3.1 major bleeding events/100 patient-years were observed in the OAT and no-OAT groups, respectively ( P = .024). Recurrent ICH was observed only in patient with OAT. Thromboembolic events occurred in 2.4 and 8.3 events/100 patient-years in OAT and no-OAT groups, respectively ( P < .001). There was no significant differences in composite end points between OAT and no-OAT groups (11.5 events/100 patient-years vs 7.9 events/100 patient-years; P = .154). Patients with OAT who achieved a time-in-therapeutic range of ≥60% of the international normalized ratio of 2.0–3.0 demonstrated a better cumulative survival free of the composite end point ( P < .001) than did patients without OAT. Early ( |
| doi_str_mv | 10.1016/j.hrthm.2016.05.016 |
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| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1814140336</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S1547527116303174</els_id><sourcerecordid>1814140336</sourcerecordid><originalsourceid>FETCH-LOGICAL-c414t-d70ae4c8a9d19e54b2b73dad63c66da987958c94817f952188e9b71f6a0b43</originalsourceid><addsrcrecordid>eNqFUcuO1DAQtBCIXRa-AAnNkUuCHdtxfABpteIljYQE3K2O09l4yGNoOyvN3-MwAwcunMpWVbna1Yy9FLwUXNRvDuVAaZjKKl9KrssMj9i10LouZGPE4-2sTKErI67YsxgPnFe25vIpu6qM1soqc832t3MKfoH7dYQUlnmXBiQ4nnZh3kGiAOOuDy2F8UJDn5AymQg8wbzxA04L0QD3-Jw96WGM-OKCN-zrh_ff7z4V-y8fP9_d7guvhEpFZzig8g3YTljUqq1aIzvoaunrugPbGKsbb1UjTG91JZoGbWtEXwNvlbxhr8-PHmn5uWJMbgrRYx5wxmWNTjQip3Ap6yyVZ6mnJUbC3h0pTEAnJ7jbOnQH97tDt3XouHYZsuvVJWBtJ-z-ev6UlgVvzwLMf3wISC76gLPHLhD65Lol_Cfg3T9-P4Y5eBh_4AnjYVlpzvU54WLluPu2rXHbYrZyKYySvwCLw5l7</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1814140336</pqid></control><display><type>article</type><title>Anticoagulation therapy in atrial fibrillation after intracranial hemorrhage</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Park, Young-Ah, MD ; Uhm, Jae-Sun, MD ; Pak, Hui-Nam, MD, PhD ; Lee, Moon-Hyoung, MD, PhD ; Joung, Boyoung, MD, PhD</creator><creatorcontrib>Park, Young-Ah, MD ; Uhm, Jae-Sun, MD ; Pak, Hui-Nam, MD, PhD ; Lee, Moon-Hyoung, MD, PhD ; Joung, Boyoung, MD, PhD</creatorcontrib><description>Background The effect of oral anticoagulation therapy (OAT) in patients with atrial fibrillation (AF) with a history of intracranial hemorrhage (ICH) is poorly defined. Objective The purpose of this study was to evaluate the efficacy and safety of OAT in patients with AF with an ICH history. Methods We retrospectively compared the composite end point, including thromboembolic and major bleeding events, between patients with AF with a history of ICH who were (OAT group, n = 254) and those who were not (no-OAT group, n = 174) taking OAT. Results During a mean follow-up of 39.5 ± 31.9 months, 5.5 and 3.1 major bleeding events/100 patient-years were observed in the OAT and no-OAT groups, respectively ( P = .024). Recurrent ICH was observed only in patient with OAT. Thromboembolic events occurred in 2.4 and 8.3 events/100 patient-years in OAT and no-OAT groups, respectively ( P < .001). There was no significant differences in composite end points between OAT and no-OAT groups (11.5 events/100 patient-years vs 7.9 events/100 patient-years; P = .154). Patients with OAT who achieved a time-in-therapeutic range of ≥60% of the international normalized ratio of 2.0–3.0 demonstrated a better cumulative survival free of the composite end point ( P < .001) than did patients without OAT. Early (<2 weeks) OAT after an index ICH did not improve composite end points because of the increased incidence of major bleeding events. However, OAT at 2 weeks after an index ICH was associated with decreased clinical events including thromboembolic events and composite end point. Conclusion In patients with AF who require anticoagulation and have a history of ICH, maintaining optimal OAT with time-in-therapeutic range ≥ 60% and the initiation of OAT at least 2 weeks after an index ICH were associated with improved clinical outcomes</description><identifier>ISSN: 1547-5271</identifier><identifier>EISSN: 1556-3871</identifier><identifier>DOI: 10.1016/j.hrthm.2016.05.016</identifier><identifier>PMID: 27554947</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Administration, Oral ; Aged ; Anticoagulants - administration & dosage ; Anticoagulants - adverse effects ; Anticoagulation ; Atrial fibrillation ; Atrial Fibrillation - complications ; Bleeding ; Cardiovascular ; Female ; Humans ; Intracranial hemorrhage ; Intracranial Hemorrhages - chemically induced ; Male ; Middle Aged ; Retrospective Studies ; Risk Assessment ; Stroke - etiology ; Stroke - prevention & control ; Thromboembolic events ; Warfarin - administration & dosage ; Warfarin - adverse effects</subject><ispartof>Heart rhythm, 2016-09, Vol.13 (9), p.1794-1802</ispartof><rights>Heart Rhythm Society</rights><rights>2016 Heart Rhythm Society</rights><rights>Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c414t-d70ae4c8a9d19e54b2b73dad63c66da987958c94817f952188e9b71f6a0b43</citedby><cites>FETCH-LOGICAL-c414t-d70ae4c8a9d19e54b2b73dad63c66da987958c94817f952188e9b71f6a0b43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1547527116303174$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27554947$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Park, Young-Ah, MD</creatorcontrib><creatorcontrib>Uhm, Jae-Sun, MD</creatorcontrib><creatorcontrib>Pak, Hui-Nam, MD, PhD</creatorcontrib><creatorcontrib>Lee, Moon-Hyoung, MD, PhD</creatorcontrib><creatorcontrib>Joung, Boyoung, MD, PhD</creatorcontrib><title>Anticoagulation therapy in atrial fibrillation after intracranial hemorrhage</title><title>Heart rhythm</title><addtitle>Heart Rhythm</addtitle><description>Background The effect of oral anticoagulation therapy (OAT) in patients with atrial fibrillation (AF) with a history of intracranial hemorrhage (ICH) is poorly defined. Objective The purpose of this study was to evaluate the efficacy and safety of OAT in patients with AF with an ICH history. Methods We retrospectively compared the composite end point, including thromboembolic and major bleeding events, between patients with AF with a history of ICH who were (OAT group, n = 254) and those who were not (no-OAT group, n = 174) taking OAT. Results During a mean follow-up of 39.5 ± 31.9 months, 5.5 and 3.1 major bleeding events/100 patient-years were observed in the OAT and no-OAT groups, respectively ( P = .024). Recurrent ICH was observed only in patient with OAT. Thromboembolic events occurred in 2.4 and 8.3 events/100 patient-years in OAT and no-OAT groups, respectively ( P < .001). There was no significant differences in composite end points between OAT and no-OAT groups (11.5 events/100 patient-years vs 7.9 events/100 patient-years; P = .154). Patients with OAT who achieved a time-in-therapeutic range of ≥60% of the international normalized ratio of 2.0–3.0 demonstrated a better cumulative survival free of the composite end point ( P < .001) than did patients without OAT. Early (<2 weeks) OAT after an index ICH did not improve composite end points because of the increased incidence of major bleeding events. However, OAT at 2 weeks after an index ICH was associated with decreased clinical events including thromboembolic events and composite end point. Conclusion In patients with AF who require anticoagulation and have a history of ICH, maintaining optimal OAT with time-in-therapeutic range ≥ 60% and the initiation of OAT at least 2 weeks after an index ICH were associated with improved clinical outcomes</description><subject>Administration, Oral</subject><subject>Aged</subject><subject>Anticoagulants - administration & dosage</subject><subject>Anticoagulants - adverse effects</subject><subject>Anticoagulation</subject><subject>Atrial fibrillation</subject><subject>Atrial Fibrillation - complications</subject><subject>Bleeding</subject><subject>Cardiovascular</subject><subject>Female</subject><subject>Humans</subject><subject>Intracranial hemorrhage</subject><subject>Intracranial Hemorrhages - chemically induced</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Stroke - etiology</subject><subject>Stroke - prevention & control</subject><subject>Thromboembolic events</subject><subject>Warfarin - administration & dosage</subject><subject>Warfarin - adverse effects</subject><issn>1547-5271</issn><issn>1556-3871</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUcuO1DAQtBCIXRa-AAnNkUuCHdtxfABpteIljYQE3K2O09l4yGNoOyvN3-MwAwcunMpWVbna1Yy9FLwUXNRvDuVAaZjKKl9KrssMj9i10LouZGPE4-2sTKErI67YsxgPnFe25vIpu6qM1soqc832t3MKfoH7dYQUlnmXBiQ4nnZh3kGiAOOuDy2F8UJDn5AymQg8wbzxA04L0QD3-Jw96WGM-OKCN-zrh_ff7z4V-y8fP9_d7guvhEpFZzig8g3YTljUqq1aIzvoaunrugPbGKsbb1UjTG91JZoGbWtEXwNvlbxhr8-PHmn5uWJMbgrRYx5wxmWNTjQip3Ap6yyVZ6mnJUbC3h0pTEAnJ7jbOnQH97tDt3XouHYZsuvVJWBtJ-z-ev6UlgVvzwLMf3wISC76gLPHLhD65Lol_Cfg3T9-P4Y5eBh_4AnjYVlpzvU54WLluPu2rXHbYrZyKYySvwCLw5l7</recordid><startdate>20160901</startdate><enddate>20160901</enddate><creator>Park, Young-Ah, MD</creator><creator>Uhm, Jae-Sun, MD</creator><creator>Pak, Hui-Nam, MD, PhD</creator><creator>Lee, Moon-Hyoung, MD, PhD</creator><creator>Joung, Boyoung, MD, PhD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20160901</creationdate><title>Anticoagulation therapy in atrial fibrillation after intracranial hemorrhage</title><author>Park, Young-Ah, MD ; Uhm, Jae-Sun, MD ; Pak, Hui-Nam, MD, PhD ; Lee, Moon-Hyoung, MD, PhD ; Joung, Boyoung, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c414t-d70ae4c8a9d19e54b2b73dad63c66da987958c94817f952188e9b71f6a0b43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Administration, Oral</topic><topic>Aged</topic><topic>Anticoagulants - administration & dosage</topic><topic>Anticoagulants - adverse effects</topic><topic>Anticoagulation</topic><topic>Atrial fibrillation</topic><topic>Atrial Fibrillation - complications</topic><topic>Bleeding</topic><topic>Cardiovascular</topic><topic>Female</topic><topic>Humans</topic><topic>Intracranial hemorrhage</topic><topic>Intracranial Hemorrhages - chemically induced</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Stroke - etiology</topic><topic>Stroke - prevention & control</topic><topic>Thromboembolic events</topic><topic>Warfarin - administration & dosage</topic><topic>Warfarin - adverse effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Park, Young-Ah, MD</creatorcontrib><creatorcontrib>Uhm, Jae-Sun, MD</creatorcontrib><creatorcontrib>Pak, Hui-Nam, MD, PhD</creatorcontrib><creatorcontrib>Lee, Moon-Hyoung, MD, PhD</creatorcontrib><creatorcontrib>Joung, Boyoung, MD, PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Heart rhythm</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Park, Young-Ah, MD</au><au>Uhm, Jae-Sun, MD</au><au>Pak, Hui-Nam, MD, PhD</au><au>Lee, Moon-Hyoung, MD, PhD</au><au>Joung, Boyoung, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Anticoagulation therapy in atrial fibrillation after intracranial hemorrhage</atitle><jtitle>Heart rhythm</jtitle><addtitle>Heart Rhythm</addtitle><date>2016-09-01</date><risdate>2016</risdate><volume>13</volume><issue>9</issue><spage>1794</spage><epage>1802</epage><pages>1794-1802</pages><issn>1547-5271</issn><eissn>1556-3871</eissn><abstract>Background The effect of oral anticoagulation therapy (OAT) in patients with atrial fibrillation (AF) with a history of intracranial hemorrhage (ICH) is poorly defined. Objective The purpose of this study was to evaluate the efficacy and safety of OAT in patients with AF with an ICH history. Methods We retrospectively compared the composite end point, including thromboembolic and major bleeding events, between patients with AF with a history of ICH who were (OAT group, n = 254) and those who were not (no-OAT group, n = 174) taking OAT. Results During a mean follow-up of 39.5 ± 31.9 months, 5.5 and 3.1 major bleeding events/100 patient-years were observed in the OAT and no-OAT groups, respectively ( P = .024). Recurrent ICH was observed only in patient with OAT. Thromboembolic events occurred in 2.4 and 8.3 events/100 patient-years in OAT and no-OAT groups, respectively ( P < .001). There was no significant differences in composite end points between OAT and no-OAT groups (11.5 events/100 patient-years vs 7.9 events/100 patient-years; P = .154). Patients with OAT who achieved a time-in-therapeutic range of ≥60% of the international normalized ratio of 2.0–3.0 demonstrated a better cumulative survival free of the composite end point ( P < .001) than did patients without OAT. Early (<2 weeks) OAT after an index ICH did not improve composite end points because of the increased incidence of major bleeding events. However, OAT at 2 weeks after an index ICH was associated with decreased clinical events including thromboembolic events and composite end point. Conclusion In patients with AF who require anticoagulation and have a history of ICH, maintaining optimal OAT with time-in-therapeutic range ≥ 60% and the initiation of OAT at least 2 weeks after an index ICH were associated with improved clinical outcomes</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27554947</pmid><doi>10.1016/j.hrthm.2016.05.016</doi><tpages>9</tpages></addata></record> |
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| subjects | Administration, Oral Aged Anticoagulants - administration & dosage Anticoagulants - adverse effects Anticoagulation Atrial fibrillation Atrial Fibrillation - complications Bleeding Cardiovascular Female Humans Intracranial hemorrhage Intracranial Hemorrhages - chemically induced Male Middle Aged Retrospective Studies Risk Assessment Stroke - etiology Stroke - prevention & control Thromboembolic events Warfarin - administration & dosage Warfarin - adverse effects |
| title | Anticoagulation therapy in atrial fibrillation after intracranial hemorrhage |
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