liu.seSearch for publications in DiVA
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Assessment of Use vs Discontinuation of Oral Anticoagulation After Pulmonary Vein Isolation in Patients With Atrial Fibrillation
Umeå University, Sweden.
Skåne University Hospital, Sweden; Lund University, Sweden.
Lund University, Sweden; Skåne University Hospital, Sweden.
Skåne University Hospital, Sweden; Lund University, Sweden.
Show others and affiliations
2017 (English)In: JAMA cardiology, ISSN 2380-6583, E-ISSN 2380-6591, Vol. 2, no 2, 146-152 p.Article in journal (Refereed) Published
Abstract [en]

IMPORTANCE Pulmonary vein isolation (PVI) is a recommended treatment for patients with atrial fibrillation, but it is unclear whether it results in a lower risk of stroke. OBJECTIVES To investigate the proportion of patients discontinuing anticoagulation treatment after PVI in association with the CHA(2)DS(2)-VASc (congestive heart failure, hypertension, age amp;gt;= 75 years [doubled], diabetes, stroke [doubled], vascular disease, age 65-74 years, sex category [female]) score, identify factors predicting stroke after PVI, and explore the risk of cardiovascular events after PVI in patients with and without guideline-recommended anticoagulation treatment. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort studywas conducted using Swedish national health registries from January 1, 2006, to December 31, 2012, with a mean-follow up of 2.6 years. A total of 1585 patients with atrial fibrillation undergoing PVI from the Swedish Catheter Ablation Register were included, with information about exposure to warfarin in the national quality register Auricula. Data analysis was performed from January 1, 2015, to April 30, 2016. EXPOSURES Warfarin treatment. MAIN OUTCOMES AND MEASURES Ischemic stroke, intracranial hemorrhage, and death. RESULTS In this cohort of 1585 patients, 73.0% were male, the mean (SD) age was 59.0 (9.4) years, and the mean (SD) CHA(2)DS(2)-VASc score was 1.5 (1.4). Of the 1585 patients, 1175 were followed up for more than 1 year after PVI. Of these, 360 (30.6%) discontinued warfarin treatment during the first year. In patients with a CHA(2)DS(2)-VASc score of 2 or more, patients discontinuing warfarin treatment had a higher rate of ischemic stroke (5 events in 312 years at risk [1.6% per year]) compared with those continuing warfarin treatment (4 events in 1192 years at risk [0.3% per year]) (P = .046). Patients with a CHA(2)DS(2)-VASc score of 2 or more or those who had previously experienced an ischemic stroke displayed a higher risk of stroke if warfarin treatment was discontinued (hazard ratio, 4.6; 95% CI, 1.2-17.2; P = .02 and hazard ratio, 13.7; 95% CI, 2.0-91.9; P = .007, respectively). CONCLUSIONS AND RELEVANCE These findings indicate that discontinuation ofwarfarin treatment after PVI is not safe in high-risk patients, especially those who have previously experienced an ischemic stroke.

Place, publisher, year, edition, pages
AMER MEDICAL ASSOC , 2017. Vol. 2, no 2, 146-152 p.
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:liu:diva-138930DOI: 10.1001/jamacardio.2016.4179ISI: 000401908200007PubMedID: 27893055OAI: oai:DiVA.org:liu-138930DiVA: diva2:1115798
Note

Funding Agencies|Department of Research and Development, County Council of Vasternorrland [LVNFOU415691, LVNFOU534001, LVNFOU481841]; Northern County Councils [VISARENORR363951]; Heart Foundation of Northern Sweden

Available from: 2017-06-27 Created: 2017-06-27 Last updated: 2017-06-27

Open Access in DiVA

No full text

Other links

Publisher's full textPubMed

Search in DiVA

By author/editor
Jonsson, Anders
By organisation
Department of Cardiology in Linköping
In the same journal
JAMA cardiology
Cardiac and Cardiovascular Systems

Search outside of DiVA

GoogleGoogle Scholar

Altmetric score

Total: 72 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf