Discontinuation of oral anticoagulation and risk of stroke and death after ablation for typical atrial flutter: A nation-wide Danish cohort study
Oral anticoagulation (OAC) is indicated for patients with atrial fibrillation (AF) and atrial flutter (AFL) with a CHA2DS2-VASc score ≥ 2 for men and ≥3 for women. This is regardless of successful catheter ablation for their arrhythmia. Studies have mainly focused on AF, and little is known regardin...
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| Veröffentlicht in: | International journal of cardiology 2021-06, Vol.333, p.110-116 |
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| creator | Giehm-Reese, Mikkel Johansen, Martin Nygård Kronborg, Mads Brix Jensen, Henrik Kjærulf Gerdes, Christian Kristensen, Jens Johannessen, Arne Jacobsen, Peter Karl Djurhuus, Mogens Stig Hansen, Peter Steen Riahi, Sam Nielsen, Jens Cosedis |
| description | Oral anticoagulation (OAC) is indicated for patients with atrial fibrillation (AF) and atrial flutter (AFL) with a CHA2DS2-VASc score ≥ 2 for men and ≥3 for women. This is regardless of successful catheter ablation for their arrhythmia. Studies have mainly focused on AF, and little is known regarding use of OAC in AFL patients following catheter ablation.
To describe discontinuation of OAC in a national cohort of patients who have undergone first-time cavo-tricuspid isthmus ablation (CTIA) for AFL.
We identified patients undergoing first-time CTIA during the period 2010–2016 using the Danish National Ablation Registry. Information on comorbidities and OAC use were gathered using the Danish National Patient Registry and the Danish National Prescription Registry. Patients were followed until March 1st, 2018.
We identified 2409 consecutive patients. Median age was 66 (IQR 58–72) years, and 1952 (81%) were men. During mean follow-up of 4 ± 1.7 years, 723 (30%) patients discontinued OAC. Patients discontinuing OAC were younger, had less comorbidity, and a lower CHA2DS2-VASc score. During follow-up, 252 (10%) patients died, and 112 (5%) patients had a stroke. Incidence of both these events increased with increasing age and CHA2DS2-VASc score. In adjusted analysis, we observed higher mortality (p |
| doi_str_mv | 10.1016/j.ijcard.2021.02.057 |
| format | Article |
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To describe discontinuation of OAC in a national cohort of patients who have undergone first-time cavo-tricuspid isthmus ablation (CTIA) for AFL.
We identified patients undergoing first-time CTIA during the period 2010–2016 using the Danish National Ablation Registry. Information on comorbidities and OAC use were gathered using the Danish National Patient Registry and the Danish National Prescription Registry. Patients were followed until March 1st, 2018.
We identified 2409 consecutive patients. Median age was 66 (IQR 58–72) years, and 1952 (81%) were men. During mean follow-up of 4 ± 1.7 years, 723 (30%) patients discontinued OAC. Patients discontinuing OAC were younger, had less comorbidity, and a lower CHA2DS2-VASc score. During follow-up, 252 (10%) patients died, and 112 (5%) patients had a stroke. Incidence of both these events increased with increasing age and CHA2DS2-VASc score. In adjusted analysis, we observed higher mortality (p < 0.0001) in patients discontinuing OAC, while stroke rate was not significantly higher (p = 0.21).
In this national cohort of patients who have undergone first-time CTIA, patients discontinuing OAC treatment were younger and had less comorbidities. Patients remain at elevated risk of death and stroke/TIA, increasing with their age and CHA2DS2-VASc score.
•In this nation-wide study, cumulative incidence of patients discontinuing OAC following CA for typical AFL was 30%.•OAC was discontinued in 12% of patients with CHA2DS2-VASc score ≥ 2 and continued in 40% with a low CHA2DS2-VASc score.•In general, younger patients with less comorbidities and without recurrent arrhythmia were more likely to discontinue OAC.•In this cohort, annual incidence rates of stroke/TIA and death was 1,3% and 2,8%, respectively.•Patients experiencing adverse events were older, had more comorbidities and more likely had recurrent arrhythmia.</description><identifier>ISSN: 0167-5273</identifier><identifier>EISSN: 1874-1754</identifier><identifier>DOI: 10.1016/j.ijcard.2021.02.057</identifier><identifier>PMID: 33647366</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Atrial flutter ; Catheter ablation ; Death ; Oral anticoagulants ; Stroke</subject><ispartof>International journal of cardiology, 2021-06, Vol.333, p.110-116</ispartof><rights>2021 Elsevier B.V.</rights><rights>Copyright © 2021 Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c362t-1da1c9eaccc9f9f3646600d17a3dfcbf01163c580030afc6ecbd8ddb5e300a393</citedby><cites>FETCH-LOGICAL-c362t-1da1c9eaccc9f9f3646600d17a3dfcbf01163c580030afc6ecbd8ddb5e300a393</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0167527321003661$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33647366$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Giehm-Reese, Mikkel</creatorcontrib><creatorcontrib>Johansen, Martin Nygård</creatorcontrib><creatorcontrib>Kronborg, Mads Brix</creatorcontrib><creatorcontrib>Jensen, Henrik Kjærulf</creatorcontrib><creatorcontrib>Gerdes, Christian</creatorcontrib><creatorcontrib>Kristensen, Jens</creatorcontrib><creatorcontrib>Johannessen, Arne</creatorcontrib><creatorcontrib>Jacobsen, Peter Karl</creatorcontrib><creatorcontrib>Djurhuus, Mogens Stig</creatorcontrib><creatorcontrib>Hansen, Peter Steen</creatorcontrib><creatorcontrib>Riahi, Sam</creatorcontrib><creatorcontrib>Nielsen, Jens Cosedis</creatorcontrib><title>Discontinuation of oral anticoagulation and risk of stroke and death after ablation for typical atrial flutter: A nation-wide Danish cohort study</title><title>International journal of cardiology</title><addtitle>Int J Cardiol</addtitle><description>Oral anticoagulation (OAC) is indicated for patients with atrial fibrillation (AF) and atrial flutter (AFL) with a CHA2DS2-VASc score ≥ 2 for men and ≥3 for women. This is regardless of successful catheter ablation for their arrhythmia. Studies have mainly focused on AF, and little is known regarding use of OAC in AFL patients following catheter ablation.
To describe discontinuation of OAC in a national cohort of patients who have undergone first-time cavo-tricuspid isthmus ablation (CTIA) for AFL.
We identified patients undergoing first-time CTIA during the period 2010–2016 using the Danish National Ablation Registry. Information on comorbidities and OAC use were gathered using the Danish National Patient Registry and the Danish National Prescription Registry. Patients were followed until March 1st, 2018.
We identified 2409 consecutive patients. Median age was 66 (IQR 58–72) years, and 1952 (81%) were men. During mean follow-up of 4 ± 1.7 years, 723 (30%) patients discontinued OAC. Patients discontinuing OAC were younger, had less comorbidity, and a lower CHA2DS2-VASc score. During follow-up, 252 (10%) patients died, and 112 (5%) patients had a stroke. Incidence of both these events increased with increasing age and CHA2DS2-VASc score. In adjusted analysis, we observed higher mortality (p < 0.0001) in patients discontinuing OAC, while stroke rate was not significantly higher (p = 0.21).
In this national cohort of patients who have undergone first-time CTIA, patients discontinuing OAC treatment were younger and had less comorbidities. Patients remain at elevated risk of death and stroke/TIA, increasing with their age and CHA2DS2-VASc score.
•In this nation-wide study, cumulative incidence of patients discontinuing OAC following CA for typical AFL was 30%.•OAC was discontinued in 12% of patients with CHA2DS2-VASc score ≥ 2 and continued in 40% with a low CHA2DS2-VASc score.•In general, younger patients with less comorbidities and without recurrent arrhythmia were more likely to discontinue OAC.•In this cohort, annual incidence rates of stroke/TIA and death was 1,3% and 2,8%, respectively.•Patients experiencing adverse events were older, had more comorbidities and more likely had recurrent arrhythmia.</description><subject>Atrial flutter</subject><subject>Catheter ablation</subject><subject>Death</subject><subject>Oral anticoagulants</subject><subject>Stroke</subject><issn>0167-5273</issn><issn>1874-1754</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kU9v1DAQxS1URLct3wAhH3tJGMeJk_RQqWqhIFXiQs_WxH9Yb7Px1nZA-zH4xnibLUdOIz395o3mPUI-MCgZMPFpU7qNwqDLCipWQlVC074hK9a1dcHapj4hq4y1RVO1_JScxbgBgLrvu3fklHNRt1yIFflz56LyU3LTjMn5iXpLfcCRYtaUx5_zuOg4aRpcfDoAMQX_ZF4kbTCtKdpkAsXhyFofaNrvnDr4pODysOOcMnNFb-j0AhW_nTb0DicX11T5tQ8p-856f0HeWhyjeX-c5-Txy-cft1-Lh-_3325vHgrFRZUKppGp3qBSqre9zQ8JAaBZi1xbNVhgTHDVdAAc0Cph1KA7rYfGcADkPT8nl4vvLvjn2cQktzkKM444GT9HWdV9U0PHO5HRekFV8DEGY-UuuC2GvWQgD2XIjVzKkIcyJFQyl5HXPh4vzMPW6H9Lr-ln4HoBTP7zlzNBRuXMpIx2wagktXf_v_AXqd-giA</recordid><startdate>20210615</startdate><enddate>20210615</enddate><creator>Giehm-Reese, Mikkel</creator><creator>Johansen, Martin Nygård</creator><creator>Kronborg, Mads Brix</creator><creator>Jensen, Henrik Kjærulf</creator><creator>Gerdes, Christian</creator><creator>Kristensen, Jens</creator><creator>Johannessen, Arne</creator><creator>Jacobsen, Peter Karl</creator><creator>Djurhuus, Mogens Stig</creator><creator>Hansen, Peter Steen</creator><creator>Riahi, Sam</creator><creator>Nielsen, Jens Cosedis</creator><general>Elsevier B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20210615</creationdate><title>Discontinuation of oral anticoagulation and risk of stroke and death after ablation for typical atrial flutter: A nation-wide Danish cohort study</title><author>Giehm-Reese, Mikkel ; Johansen, Martin Nygård ; Kronborg, Mads Brix ; Jensen, Henrik Kjærulf ; Gerdes, Christian ; Kristensen, Jens ; Johannessen, Arne ; Jacobsen, Peter Karl ; Djurhuus, Mogens Stig ; Hansen, Peter Steen ; Riahi, Sam ; Nielsen, Jens Cosedis</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c362t-1da1c9eaccc9f9f3646600d17a3dfcbf01163c580030afc6ecbd8ddb5e300a393</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Atrial flutter</topic><topic>Catheter ablation</topic><topic>Death</topic><topic>Oral anticoagulants</topic><topic>Stroke</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Giehm-Reese, Mikkel</creatorcontrib><creatorcontrib>Johansen, Martin Nygård</creatorcontrib><creatorcontrib>Kronborg, Mads Brix</creatorcontrib><creatorcontrib>Jensen, Henrik Kjærulf</creatorcontrib><creatorcontrib>Gerdes, Christian</creatorcontrib><creatorcontrib>Kristensen, Jens</creatorcontrib><creatorcontrib>Johannessen, Arne</creatorcontrib><creatorcontrib>Jacobsen, Peter Karl</creatorcontrib><creatorcontrib>Djurhuus, Mogens Stig</creatorcontrib><creatorcontrib>Hansen, Peter Steen</creatorcontrib><creatorcontrib>Riahi, Sam</creatorcontrib><creatorcontrib>Nielsen, Jens Cosedis</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Giehm-Reese, Mikkel</au><au>Johansen, Martin Nygård</au><au>Kronborg, Mads Brix</au><au>Jensen, Henrik Kjærulf</au><au>Gerdes, Christian</au><au>Kristensen, Jens</au><au>Johannessen, Arne</au><au>Jacobsen, Peter Karl</au><au>Djurhuus, Mogens Stig</au><au>Hansen, Peter Steen</au><au>Riahi, Sam</au><au>Nielsen, Jens Cosedis</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Discontinuation of oral anticoagulation and risk of stroke and death after ablation for typical atrial flutter: A nation-wide Danish cohort study</atitle><jtitle>International journal of cardiology</jtitle><addtitle>Int J Cardiol</addtitle><date>2021-06-15</date><risdate>2021</risdate><volume>333</volume><spage>110</spage><epage>116</epage><pages>110-116</pages><issn>0167-5273</issn><eissn>1874-1754</eissn><abstract>Oral anticoagulation (OAC) is indicated for patients with atrial fibrillation (AF) and atrial flutter (AFL) with a CHA2DS2-VASc score ≥ 2 for men and ≥3 for women. This is regardless of successful catheter ablation for their arrhythmia. Studies have mainly focused on AF, and little is known regarding use of OAC in AFL patients following catheter ablation.
To describe discontinuation of OAC in a national cohort of patients who have undergone first-time cavo-tricuspid isthmus ablation (CTIA) for AFL.
We identified patients undergoing first-time CTIA during the period 2010–2016 using the Danish National Ablation Registry. Information on comorbidities and OAC use were gathered using the Danish National Patient Registry and the Danish National Prescription Registry. Patients were followed until March 1st, 2018.
We identified 2409 consecutive patients. Median age was 66 (IQR 58–72) years, and 1952 (81%) were men. During mean follow-up of 4 ± 1.7 years, 723 (30%) patients discontinued OAC. Patients discontinuing OAC were younger, had less comorbidity, and a lower CHA2DS2-VASc score. During follow-up, 252 (10%) patients died, and 112 (5%) patients had a stroke. Incidence of both these events increased with increasing age and CHA2DS2-VASc score. In adjusted analysis, we observed higher mortality (p < 0.0001) in patients discontinuing OAC, while stroke rate was not significantly higher (p = 0.21).
In this national cohort of patients who have undergone first-time CTIA, patients discontinuing OAC treatment were younger and had less comorbidities. Patients remain at elevated risk of death and stroke/TIA, increasing with their age and CHA2DS2-VASc score.
•In this nation-wide study, cumulative incidence of patients discontinuing OAC following CA for typical AFL was 30%.•OAC was discontinued in 12% of patients with CHA2DS2-VASc score ≥ 2 and continued in 40% with a low CHA2DS2-VASc score.•In general, younger patients with less comorbidities and without recurrent arrhythmia were more likely to discontinue OAC.•In this cohort, annual incidence rates of stroke/TIA and death was 1,3% and 2,8%, respectively.•Patients experiencing adverse events were older, had more comorbidities and more likely had recurrent arrhythmia.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>33647366</pmid><doi>10.1016/j.ijcard.2021.02.057</doi><tpages>7</tpages></addata></record> |
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| source | Elsevier ScienceDirect Journals |
| subjects | Atrial flutter Catheter ablation Death Oral anticoagulants Stroke |
| title | Discontinuation of oral anticoagulation and risk of stroke and death after ablation for typical atrial flutter: A nation-wide Danish cohort study |
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