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Assessment of Use vs Discontinuation of Oral Anticoagulation After Pulmonary Vein Isolation in Patients With Atrial Fibrillation
Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Arrhythmia Clinic, Skåne University Hospital, Lund, Sweden; Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden .
Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden; Department of Heart Failure and Valvular Disease, Skåne University Hospital, Lund, Sweden .
Arrhythmia Clinic, Skåne University Hospital, Lund, Sweden; Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden .
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2017 (English)In: JAMA cardiology, ISSN 2380-6583, E-ISSN 2380-6591, Vol. 2, no 2, p. 146-152Article 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 >= 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
American Medical Association , 2017. Vol. 2, no 2, p. 146-152
National Category
Cardiology and Cardiovascular Disease
Identifiers
URN: urn:nbn:se:oru:diva-58793DOI: 10.1001/jamacardio.2016.4179ISI: 000401908200007PubMedID: 27893055Scopus ID: 2-s2.0-85020602105OAI: oai:DiVA.org:oru-58793DiVA, id: diva2:1128556
Note

Funding Agencies:

Department of Research and Development, County Council of Västernorrland  LVNFOU415691  LVNFOU534001  LVNFOU481841 

Northern County Councils  VISARENORR363951 

Heart Foundation of Northern Sweden 

Available from: 2017-07-26 Created: 2017-07-26 Last updated: 2025-02-10Bibliographically approved

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