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Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182 678 patients with atrial fibrillation: the Swedish Atrial Fibrillation cohort study
Abstract
Aims The impact of some risk factors for stroke and bleeding, and the value of stroke and bleeding risk scores, in atrial fibrillation (AF), has been debated, as clinical trial cohorts have not adequately tested these. Our objective was to investigate risk factors for stroke and bleeding in AF, and application of the new CHA(2)DS(2)-VASc and HAS-BLED schemes for stroke and bleeding risk assessments, respectively. Methods and results We used the Swedish Atrial Fibrillation cohort study, a nationwide cohort study of 182 678 subjects with a diagnosis of AF at any Swedish hospital between 1 July 2005 and 31 December 2008, who were prospectively followed for an average of 1.5 years (260 000 years at risk). With the use of the National Swedish Drug Registry, all patients who used an oral anticoagulant anytime during follow-up were identified. Most of the analyses were made on a subset of 90 490 patients who never used anticoagulants. Risk factors for stroke, the composite thromboembolism endpoint (stroke, TIA, or systemic embolism), and bleeding, and the performance of published stroke and bleeding risk stratification schemes were investigated. On multivariable analysis, significant associations were found between the following 'new' risk factors and thromboembolic events; peripheral artery disease [hazard ratio (HR) 1.22 (95% CI 1.12-1.32)], 'vascular disease' [HR 1.14 (1.06-1.23)], prior myocardial infarction [HR 1.09 (1.03-1.15)], and female gender [HR 1.17 (1.11-1.22)]. Previou…
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“For example, older age is one of the most important predictors of both ischaemic stroke and bleeding in AF patients.386,387”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [386]
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Metadata
- Authors
- Friberg, L., Rosenqvist, M., & Lip, G. Y. H.
- Affiliations
- Danderyds sjukhus (SE)
- Karolinska Institutet (SE)
- Birmingham City Hospital (GB)
- Corresponding author
- Lip, Gregory Y.H.
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-01-13
- Volume
- 33
- Issue
- 12
- Pages
- 1500-1510
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W2124601103
- Cited by
- 1,192
- References
- 48
- Citations by year
- 2026: 37 · 2025: 60 · 2024: 74 · 2023: 81 · 2022: 112 · 2021: 99 · 2020: 100 · 2019: 99 · 2018: 78 · 2017: 99 · 2016: 75 · 2015: 99 · 2014: 72 · 2013: 68 · 2012: 35
- FWCI
- 56.38
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Funders
- Stockholms Läns Landsting
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Clinical Neurology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Keywords
- atrial fibrillation, stroke risk stratification, bleeding risk stratification, CHA2DS2-VASc score, HAS-BLED score, thromboembolism, intracranial hemorrhage, risk factors, peripheral arterial disease, oral anticoagulants, thyroid dysfunction, hyperthyroidism, concordance index
- MeSH terms
- Adult, Aged, Anticoagulants, Atrial Fibrillation, Female, Hemorrhage, Humans, Male, Middle Aged, Risk Factors, Sweden, Thromboembolism, Cohort Studies, Risk Assessment, Stroke
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