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Cited by 187Atrial Fibrillation Management and OutcomesVenous Thromboembolism Diagnosis and ManagementAcute Ischemic Stroke Management

Cessation of oral anticoagulation in relation to mortality and the risk of thrombotic events in patients with atrial fibrillation

Gallego, Pilar, Roldan, Vanessa, Marín, Francisco, Romera, Marta, Valdés, Mariano, Vicente, Vicente, Lip, Gregory Y. H.·2013·Thrombosis and Haemostasis
DOI 10.1160/th13-07-0556
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Abstract

Summary: Bleeding risk (often perceived, rather than actual) is a common reason for cessation of oral anticoagulation with Vitamin K antagonists (VKA). We investigate clinical outcomes in a consecutive population of VKA naïve atrial fibrillation (AF) patients, who initiated VKA therapy in our clinic. We included consecutive VKA-naíve patients with non valvular AF, initiated on VKA therapy in our anticoagulation outpatient clinic in 2009. During follow-up, adverse events [thrombotic/vascular events (stroke, acute coronary syndrome, acute heart failure and cardiac death), major bleeding and death], and VKA cessation were recorded. At the end of the follow-up, we determined time within therapeutic range (TTR), using a linear approximation (Rosendaal method). We studied 529 patients (49% male, median age 76), median follow-up 835 days (IQR 719−954). During this period 114 patients stopped VKA treatment. 63 patients suffered a thrombotic/cardiovascular event (5.17%/year, 27 thrombotic/ischaemic strokes), 51 major bleeding (4.19%/year) and 48 died (3.94%/year). Median TTR was 54% (34a57). On multivariate analysis (adjusted by CHA2DS2-VASc score), VKA cessation was associated with death [Hazard Ratio (HR) 3.43; p<0.001], stroke [4.21; p=0.001] and thrombotic/cardiovascular events [2.72; p<0.001]. Independent risk factors for major bleeding were age [1.08; p<0.001], previous stroke [1.85; p=0.049], and TTR [0.97; p=0.001], but not VKA cessation. In conclusion, in AF patients AF, VKA cessation is independently associated with mortality stroke and cardiovascular events. Specifically, VKA cessation independently increased the risk of stroke, even after adjusting for CHA2DS2-VASc score. TTR was an independent risk factor for major bleeding following initiation of VKA therapy. Note: The editorial process for this paper was fully handled by Prof Christian Weber, Editor in Chief.

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Crossref · 10.1160/th13-07-0556

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Authors
Gallego, P., Roldan, V., Marín, F., Romera, M., Valdés, M., Vicente, V., & Lip, G. Y. H.
Affiliations
Birmingham City Hospital (GB)
ORCID
Venue
Thrombosis and Haemostasis
Publisher
Georg Thieme Verlag KG
Published
2013
Volume
110
Issue
12
Pages
1189-1198
ISSN
  • 0340-6245 (ISSN-L)
  • 2567-689X
DOI
10.1160/th13-07-0556
OpenAlex
W2114112775
Cited by
187
References
35
Citations by year
2026: 1 · 2024: 1 · 2023: 2 · 2022: 3 · 2021: 7 · 2020: 8 · 2019: 3 · 2018: 8 · 2017: 19 · 2016: 24 · 2015: 59 · 2014: 50 · 2013: 2
FWCI
30.60
Type
journal article
Language
en
Open access
closed
Locations
  • Thrombosis and Haemostasis (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
  • Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
  • Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
Keywords
vitamin K antagonists, atrial fibrillation, non-valvular atrial fibrillation, time in therapeutic range, major bleeding, stroke, cardiovascular events, mortality, CHA2DS2-VASc score, bleeding risk
MeSH terms
Administration, Oral, Aged, Aged, 80 and over, Anticoagulants, Atrial Fibrillation, Female, Follow-Up Studies, Humans, Male, Risk, Thrombosis, Vitamin K, Survival Analysis, Withholding Treatment

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