Thromboembolic and haemorrhagic events in patients with atrial fibrillation: a prospective cohort study in UK primary and secondary care
Strong evidence on the long-term safety and efficacy of different types of anticoagulants would help clinicians to prevent thromboembolic events among patients with atrial fibrillation (AF) while minimising the risk of haemorrhages. To estimate the risk of thromboembolic and haemorrhagic events for...
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| Veröffentlicht in: | British journal of general practice 2019-06, Vol.69 (683), p.e407-e412 |
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| creator | Robson, John Mathur, Rohini Priebe, Marian Ahmed, Zaheer Ayerbe, Luis |
| description | Strong evidence on the long-term safety and efficacy of different types of anticoagulants would help clinicians to prevent thromboembolic events among patients with atrial fibrillation (AF) while minimising the risk of haemorrhages.
To estimate the risk of thromboembolic and haemorrhagic events for patients with AF on antiplatelets or anticoagulants.
This was a cohort study using routinely collected UK primary and secondary care clinical data from patients with AF, aged ≥18 years, and with an indication to receive anticoagulation before April 2012.
The risk of ischaemic stroke or transient ischaemic attack (TIA), coronary heart disease (CHD), peripheral artery disease (PAD), or gastrointestinal (GI) haemorrhage, between 1 April 2012 and 1 April 2017, was estimated using multivariate Cox regression models for patients on antiplatelets only, a combination of antiplatelets and vitamin K antagonists (VKAs), or novel oral anticoagulants (NOACs), and compared with those on VKAs only.
Compared with VKAs, antiplatelets were associated with a higher risk of stroke or TIA, hazard ratio (HR) 1.51, 95% confidence interval (CI) = 1.09 to 2.09, and GI haemorrhage, HR 1.79, 95% CI = 1.01 to 3.18. The risk of thromboembolic and haemorrhagic events was similar for those on a combination of antiplatelets and VKAs, or those on VKAs only. The risk was also similar for those on NOACs or VKAs, except for CHD, where it was higher for patients on NOACs, HR 2.07, 95% CI = 1.35 to 3.19.
Anticoagulants are associated with lower risk of thromboembolic and haemorrhagic events among patients with AF than antiplatelets. More research is required on the risk associated with VKAs or NOACs. |
| doi_str_mv | 10.3399/bjgp19X702269 |
| format | Article |
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To estimate the risk of thromboembolic and haemorrhagic events for patients with AF on antiplatelets or anticoagulants.
This was a cohort study using routinely collected UK primary and secondary care clinical data from patients with AF, aged ≥18 years, and with an indication to receive anticoagulation before April 2012.
The risk of ischaemic stroke or transient ischaemic attack (TIA), coronary heart disease (CHD), peripheral artery disease (PAD), or gastrointestinal (GI) haemorrhage, between 1 April 2012 and 1 April 2017, was estimated using multivariate Cox regression models for patients on antiplatelets only, a combination of antiplatelets and vitamin K antagonists (VKAs), or novel oral anticoagulants (NOACs), and compared with those on VKAs only.
Compared with VKAs, antiplatelets were associated with a higher risk of stroke or TIA, hazard ratio (HR) 1.51, 95% confidence interval (CI) = 1.09 to 2.09, and GI haemorrhage, HR 1.79, 95% CI = 1.01 to 3.18. The risk of thromboembolic and haemorrhagic events was similar for those on a combination of antiplatelets and VKAs, or those on VKAs only. The risk was also similar for those on NOACs or VKAs, except for CHD, where it was higher for patients on NOACs, HR 2.07, 95% CI = 1.35 to 3.19.
Anticoagulants are associated with lower risk of thromboembolic and haemorrhagic events among patients with AF than antiplatelets. More research is required on the risk associated with VKAs or NOACs.</description><identifier>ISSN: 0960-1643</identifier><identifier>EISSN: 1478-5242</identifier><identifier>DOI: 10.3399/bjgp19X702269</identifier><identifier>PMID: 31015222</identifier><language>eng</language><publisher>England: Royal College of General Practitioners</publisher><subject>Aged ; Aged, 80 and over ; Anticoagulants ; Anticoagulants - therapeutic use ; Atrial Fibrillation - complications ; Brain Ischemia - epidemiology ; Cardiac arrhythmia ; Cohort analysis ; Cohort Studies ; Disease prevention ; Female ; Gastrointestinal Hemorrhage - epidemiology ; Health risk assessment ; Hemorrhage ; Humans ; Inpatient care ; Male ; Middle Aged ; Platelet Aggregation Inhibitors - therapeutic use ; Primary care ; Primary Health Care ; Proportional Hazards Models ; Secondary Care ; Stroke - epidemiology ; Thromboembolism ; Thromboembolism - epidemiology ; United Kingdom</subject><ispartof>British journal of general practice, 2019-06, Vol.69 (683), p.e407-e412</ispartof><rights>British Journal of General Practice 2019.</rights><rights>Copyright Royal College of General Practitioners Jun 2019</rights><rights>British Journal of General Practice 2019 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c371t-d4644c536f02f45c22affd2b3345ad5d9d02f6a8f03d82f7c480f4cb356e4f5c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6532794/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6532794/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31015222$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Robson, John</creatorcontrib><creatorcontrib>Mathur, Rohini</creatorcontrib><creatorcontrib>Priebe, Marian</creatorcontrib><creatorcontrib>Ahmed, Zaheer</creatorcontrib><creatorcontrib>Ayerbe, Luis</creatorcontrib><title>Thromboembolic and haemorrhagic events in patients with atrial fibrillation: a prospective cohort study in UK primary and secondary care</title><title>British journal of general practice</title><addtitle>Br J Gen Pract</addtitle><description>Strong evidence on the long-term safety and efficacy of different types of anticoagulants would help clinicians to prevent thromboembolic events among patients with atrial fibrillation (AF) while minimising the risk of haemorrhages.
To estimate the risk of thromboembolic and haemorrhagic events for patients with AF on antiplatelets or anticoagulants.
This was a cohort study using routinely collected UK primary and secondary care clinical data from patients with AF, aged ≥18 years, and with an indication to receive anticoagulation before April 2012.
The risk of ischaemic stroke or transient ischaemic attack (TIA), coronary heart disease (CHD), peripheral artery disease (PAD), or gastrointestinal (GI) haemorrhage, between 1 April 2012 and 1 April 2017, was estimated using multivariate Cox regression models for patients on antiplatelets only, a combination of antiplatelets and vitamin K antagonists (VKAs), or novel oral anticoagulants (NOACs), and compared with those on VKAs only.
Compared with VKAs, antiplatelets were associated with a higher risk of stroke or TIA, hazard ratio (HR) 1.51, 95% confidence interval (CI) = 1.09 to 2.09, and GI haemorrhage, HR 1.79, 95% CI = 1.01 to 3.18. The risk of thromboembolic and haemorrhagic events was similar for those on a combination of antiplatelets and VKAs, or those on VKAs only. The risk was also similar for those on NOACs or VKAs, except for CHD, where it was higher for patients on NOACs, HR 2.07, 95% CI = 1.35 to 3.19.
Anticoagulants are associated with lower risk of thromboembolic and haemorrhagic events among patients with AF than antiplatelets. More research is required on the risk associated with VKAs or NOACs.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anticoagulants</subject><subject>Anticoagulants - therapeutic use</subject><subject>Atrial Fibrillation - complications</subject><subject>Brain Ischemia - epidemiology</subject><subject>Cardiac arrhythmia</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Disease prevention</subject><subject>Female</subject><subject>Gastrointestinal Hemorrhage - epidemiology</subject><subject>Health risk assessment</subject><subject>Hemorrhage</subject><subject>Humans</subject><subject>Inpatient care</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Platelet Aggregation Inhibitors - therapeutic use</subject><subject>Primary care</subject><subject>Primary Health Care</subject><subject>Proportional Hazards Models</subject><subject>Secondary Care</subject><subject>Stroke - epidemiology</subject><subject>Thromboembolism</subject><subject>Thromboembolism - epidemiology</subject><subject>United Kingdom</subject><issn>0960-1643</issn><issn>1478-5242</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkUtrFTEYhoMo9lhdupWAGzejuc_EhVCKVbHgpgV3IZPLmRxmJmOSOdJ_4M9uTnss1kVI8r0P73cD4DVG7ymV8kO_2y5Y_mwRIUI-ARvM2q7hhJGnYIOkQA0WjJ6AFznv0IHB6Dk4oRhhTgjZgD9XQ4pTH109YzBQzxYO2k0xpUFva8Dt3VwyDDNcdAl379-hDFCXFPQIfehTGMcqxfkj1HBJMS_OlLB30MQhpgJzWe3NweD6e5XDpNPNXZrsTJzt4Wd0ci_BM6_H7F4d71NwffH56vxrc_njy7fzs8vG0BaXxjLBmOFUeEQ844YQ7b0lPaWMa8uttDUudOcRtR3xrWEd8sz0lAvHPDf0FHy6913WfnLW1I6SHtWxMBV1UI-VOQxqG_dKcEpayarBu6NBir9Wl4uaQjauzmB2cc2KEEwlFoK3FX37H7qLa5pre5VipG1Zh2WlmnvK1Nnl5PxDMRipw47Vox1X_s2_HTzQf5dKbwEGK6aE</recordid><startdate>20190601</startdate><enddate>20190601</enddate><creator>Robson, John</creator><creator>Mathur, Rohini</creator><creator>Priebe, Marian</creator><creator>Ahmed, Zaheer</creator><creator>Ayerbe, Luis</creator><general>Royal College of General Practitioners</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>ASE</scope><scope>FPQ</scope><scope>K6X</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20190601</creationdate><title>Thromboembolic and haemorrhagic events in patients with atrial fibrillation: a prospective cohort study in UK primary and secondary care</title><author>Robson, John ; Mathur, Rohini ; Priebe, Marian ; Ahmed, Zaheer ; Ayerbe, Luis</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c371t-d4644c536f02f45c22affd2b3345ad5d9d02f6a8f03d82f7c480f4cb356e4f5c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anticoagulants</topic><topic>Anticoagulants - therapeutic use</topic><topic>Atrial Fibrillation - complications</topic><topic>Brain Ischemia - epidemiology</topic><topic>Cardiac arrhythmia</topic><topic>Cohort analysis</topic><topic>Cohort Studies</topic><topic>Disease prevention</topic><topic>Female</topic><topic>Gastrointestinal Hemorrhage - epidemiology</topic><topic>Health risk assessment</topic><topic>Hemorrhage</topic><topic>Humans</topic><topic>Inpatient care</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Platelet Aggregation Inhibitors - therapeutic use</topic><topic>Primary care</topic><topic>Primary Health Care</topic><topic>Proportional Hazards Models</topic><topic>Secondary Care</topic><topic>Stroke - epidemiology</topic><topic>Thromboembolism</topic><topic>Thromboembolism - epidemiology</topic><topic>United Kingdom</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Robson, John</creatorcontrib><creatorcontrib>Mathur, Rohini</creatorcontrib><creatorcontrib>Priebe, Marian</creatorcontrib><creatorcontrib>Ahmed, Zaheer</creatorcontrib><creatorcontrib>Ayerbe, Luis</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>British journal of general practice</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Robson, John</au><au>Mathur, Rohini</au><au>Priebe, Marian</au><au>Ahmed, Zaheer</au><au>Ayerbe, Luis</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Thromboembolic and haemorrhagic events in patients with atrial fibrillation: a prospective cohort study in UK primary and secondary care</atitle><jtitle>British journal of general practice</jtitle><addtitle>Br J Gen Pract</addtitle><date>2019-06-01</date><risdate>2019</risdate><volume>69</volume><issue>683</issue><spage>e407</spage><epage>e412</epage><pages>e407-e412</pages><issn>0960-1643</issn><eissn>1478-5242</eissn><abstract>Strong evidence on the long-term safety and efficacy of different types of anticoagulants would help clinicians to prevent thromboembolic events among patients with atrial fibrillation (AF) while minimising the risk of haemorrhages.
To estimate the risk of thromboembolic and haemorrhagic events for patients with AF on antiplatelets or anticoagulants.
This was a cohort study using routinely collected UK primary and secondary care clinical data from patients with AF, aged ≥18 years, and with an indication to receive anticoagulation before April 2012.
The risk of ischaemic stroke or transient ischaemic attack (TIA), coronary heart disease (CHD), peripheral artery disease (PAD), or gastrointestinal (GI) haemorrhage, between 1 April 2012 and 1 April 2017, was estimated using multivariate Cox regression models for patients on antiplatelets only, a combination of antiplatelets and vitamin K antagonists (VKAs), or novel oral anticoagulants (NOACs), and compared with those on VKAs only.
Compared with VKAs, antiplatelets were associated with a higher risk of stroke or TIA, hazard ratio (HR) 1.51, 95% confidence interval (CI) = 1.09 to 2.09, and GI haemorrhage, HR 1.79, 95% CI = 1.01 to 3.18. The risk of thromboembolic and haemorrhagic events was similar for those on a combination of antiplatelets and VKAs, or those on VKAs only. The risk was also similar for those on NOACs or VKAs, except for CHD, where it was higher for patients on NOACs, HR 2.07, 95% CI = 1.35 to 3.19.
Anticoagulants are associated with lower risk of thromboembolic and haemorrhagic events among patients with AF than antiplatelets. More research is required on the risk associated with VKAs or NOACs.</abstract><cop>England</cop><pub>Royal College of General Practitioners</pub><pmid>31015222</pmid><doi>10.3399/bjgp19X702269</doi><oa>free_for_read</oa></addata></record> |
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| ispartof | British journal of general practice, 2019-06, Vol.69 (683), p.e407-e412 |
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| subjects | Aged Aged, 80 and over Anticoagulants Anticoagulants - therapeutic use Atrial Fibrillation - complications Brain Ischemia - epidemiology Cardiac arrhythmia Cohort analysis Cohort Studies Disease prevention Female Gastrointestinal Hemorrhage - epidemiology Health risk assessment Hemorrhage Humans Inpatient care Male Middle Aged Platelet Aggregation Inhibitors - therapeutic use Primary care Primary Health Care Proportional Hazards Models Secondary Care Stroke - epidemiology Thromboembolism Thromboembolism - epidemiology United Kingdom |
| title | Thromboembolic and haemorrhagic events in patients with atrial fibrillation: a prospective cohort study in UK primary and secondary care |
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