Antithrombotic therapy use and clinical outcomes following thrombo-embolic events in patients with atrial fibrillation : insights from ARISTOTLE

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Goto , S , Merrill , P , Wallentin , L , Wojdyla , D M , Hanna , M , Avezum , A , Easton , J D , Harjola , V-P , Huber , K , Lewis , B S , Parkhomenko , A , Zhu , J , Granger , C B , Lopes , R D & Alexander , J H 2018 , ' Antithrombotic therapy use and clinical outcomes following thrombo-embolic events in patients with atrial fibrillation : insights from ARISTOTLE ' , European Heart Journal - Cardiovascular Pharmacotherapy , vol. 4 , no. 2 , pp. 75-81 . https://doi.org/10.1093/ehjcvp/pvy002

Title: Antithrombotic therapy use and clinical outcomes following thrombo-embolic events in patients with atrial fibrillation : insights from ARISTOTLE
Author: Goto, Shinya; Merrill, Peter; Wallentin, Lars; Wojdyla, Daniel M.; Hanna, Michael; Avezum, Alvaro; Easton, J. Donald; Harjola, Veli-Pekka; Huber, Kurt; Lewis, Basil S.; Parkhomenko, Alexander; Zhu, Jun; Granger, Christopher B.; Lopes, Renato D.; Alexander, John H.
Contributor organization: HUS Emergency Medicine and Services
Clinicum
Department of Diagnostics and Therapeutics
University of Helsinki
Date: 2018-04
Language: eng
Number of pages: 7
Belongs to series: European Heart Journal - Cardiovascular Pharmacotherapy
ISSN: 2055-6837
DOI: https://doi.org/10.1093/ehjcvp/pvy002
URI: http://hdl.handle.net/10138/299450
Abstract: Aims We investigated baseline characteristics, antithrombotic use, and clinical outcomes of patients with atrial fibrillation (AF) and a thrombo-embolic event in the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) study to better inform the care of these high-risk patients. Method and results Thrombo-embolic events were defined as stroke (ischaemic or unknown cause) or systemic embolism (SE). Clinical outcomes were estimated using the Kaplan-Meier method. All-cause mortality and International Society on Thrombosis and Haemostasis (ISTH) major bleeding after events were analysed using a Cox proportional hazards model with time-dependent covariates. Of 18 201 patients in ARISTOTLE, 365 experienced a thrombo-embolic event [337 strokes (ischaemic or unknown cause), 28 SE]; 46 (12.6%) of which were fatal. In the 30 days before and after a thrombo-embolic event, 11% and 37% of patients, respectively, were not taking an oral anticoagulant. During follow-up (median 1.8 years), 22 patients (7.1%/year) had a recurrent stroke, 97 (30.1%/year) died, and 10 (6.7%/year) had major bleeding. Compared with patients without a thrombo-embolic event, the short-and long-term adjusted hazards of death in patients with a thrombo-embolic event were high [30 days: HR 3.5, 95% CI 2.5-4.8; both P Conclusions Thrombo-embolic events were rare but associated with high short-and long-term morbidity and mortality. Substantial numbers of patients are not receiving oral anticoagulattherapy before and, despite this risk, after a first thrombo-embolic event.
Subject: Antithrombotic therapy
Thrombo-embolic events
Atrial fibrillation
ACUTE ISCHEMIC-STROKE
WARFARIN
APIXABAN
ANTICOAGULATION
317 Pharmacy
3121 General medicine, internal medicine and other clinical medicine
3126 Surgery, anesthesiology, intensive care, radiology
Peer reviewed: Yes
Usage restriction: openAccess
Self-archived version: publishedVersion


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