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Association between antithrombotic treatment and hemorrhagic stroke in patients with atrial fibrillation—a cohort study in primary care

Wändell, Per LU ; Carlsson, Axel C.; Holzmann, Martin; Ärnlöv, Johan; Johansson, Sven Erik LU ; Sundquist, Jan LU and Sundquist, Kristina LU (2017) In European Journal of Clinical Pharmacology 73(2). p.215-221
Abstract

Objective: The objective of this study was to study the association between antithrombotic treatment and risk of hemorrhagic stroke (HS) in patients with atrial fibrillation (AF) treated in primary health care. Methods: Study population included all adults (n = 12,215) 45 years and older diagnosed with AF at 75 primary care centers in Sweden 2001–2007. Outcome was defined as a first hospital episode with a discharge episode of HS after the AF diagnosis. Association between HS and persistent treatment with antithrombotic agents (warfarin, acetylsalicylic acid (ASA), clopidogrel) was explored using Cox regression analysis, with hazard ratios (HRs) and 95 % CIs. Adjustment was made for age, socioeconomic status, and co-morbid... (More)

Objective: The objective of this study was to study the association between antithrombotic treatment and risk of hemorrhagic stroke (HS) in patients with atrial fibrillation (AF) treated in primary health care. Methods: Study population included all adults (n = 12,215) 45 years and older diagnosed with AF at 75 primary care centers in Sweden 2001–2007. Outcome was defined as a first hospital episode with a discharge episode of HS after the AF diagnosis. Association between HS and persistent treatment with antithrombotic agents (warfarin, acetylsalicylic acid (ASA), clopidogrel) was explored using Cox regression analysis, with hazard ratios (HRs) and 95 % CIs. Adjustment was made for age, socioeconomic status, and co-morbid cardiovascular conditions. Results: During a mean of 5.8 years (SD 2.4) of follow-up, 162 patients (1.3 %; 67 women and 95 men) with HS were recorded. The adjusted risk associated with persistent warfarin treatment compared to no antithrombotic treatment consistently showed no increased HS risk, HR for women 0.53 (95 % CI 0.23–1.27) and for men 0.55 (95 % CI 0.29–1.04); corresponding HRs for ASA were, for women, 0.45 (95 % CI 0.14–1.44) and, for men, 0.56 (95 % CI 0.24–1.29). Conclusions: In this clinical setting, we found no evidence pointing to an increased risk of HS with antithrombotic treatment.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Anticoagulants, Atrial fibrillation, Cardiovascular co-morbidity, Gender, Hemorrhagic stroke, Mortality
in
European Journal of Clinical Pharmacology
volume
73
issue
2
pages
215 - 221
publisher
Springer
external identifiers
  • scopus:84994416010
  • wos:000392308200010
ISSN
0031-6970
DOI
10.1007/s00228-016-2152-8
language
English
LU publication?
yes
id
e4a589d6-8469-4217-a4e7-b0b3a0944c45
date added to LUP
2016-11-29 08:26:14
date last changed
2018-01-07 11:37:30
@article{e4a589d6-8469-4217-a4e7-b0b3a0944c45,
  abstract     = {<p>Objective: The objective of this study was to study the association between antithrombotic treatment and risk of hemorrhagic stroke (HS) in patients with atrial fibrillation (AF) treated in primary health care. Methods: Study population included all adults (n = 12,215) 45 years and older diagnosed with AF at 75 primary care centers in Sweden 2001–2007. Outcome was defined as a first hospital episode with a discharge episode of HS after the AF diagnosis. Association between HS and persistent treatment with antithrombotic agents (warfarin, acetylsalicylic acid (ASA), clopidogrel) was explored using Cox regression analysis, with hazard ratios (HRs) and 95 % CIs. Adjustment was made for age, socioeconomic status, and co-morbid cardiovascular conditions. Results: During a mean of 5.8 years (SD 2.4) of follow-up, 162 patients (1.3 %; 67 women and 95 men) with HS were recorded. The adjusted risk associated with persistent warfarin treatment compared to no antithrombotic treatment consistently showed no increased HS risk, HR for women 0.53 (95 % CI 0.23–1.27) and for men 0.55 (95 % CI 0.29–1.04); corresponding HRs for ASA were, for women, 0.45 (95 % CI 0.14–1.44) and, for men, 0.56 (95 % CI 0.24–1.29). Conclusions: In this clinical setting, we found no evidence pointing to an increased risk of HS with antithrombotic treatment.</p>},
  author       = {Wändell, Per and Carlsson, Axel C. and Holzmann, Martin and Ärnlöv, Johan and Johansson, Sven Erik and Sundquist, Jan and Sundquist, Kristina},
  issn         = {0031-6970},
  keyword      = {Anticoagulants,Atrial fibrillation,Cardiovascular co-morbidity,Gender,Hemorrhagic stroke,Mortality},
  language     = {eng},
  number       = {2},
  pages        = {215--221},
  publisher    = {Springer},
  series       = {European Journal of Clinical Pharmacology},
  title        = {Association between antithrombotic treatment and hemorrhagic stroke in patients with atrial fibrillation—a cohort study in primary care},
  url          = {http://dx.doi.org/10.1007/s00228-016-2152-8},
  volume       = {73},
  year         = {2017},
}