Abstract | BACKGROUND AND PURPOSE: METHODS: This is an analysis of the Atrial Fibrillation Investigators database, which contains patient level-data from randomized trials of stroke prevention in atrial fibrillation. We used Cox regression models with age as a continuous variable that controlled for sex, year of randomization, and history of cerebrovascular disease, diabetes, hypertension, and congestive heart failure. Outcomes included ischemic stroke, serious bleeding ( intracranial hemorrhage or systemic bleeding requiring hospitalization, transfusion, or surgery), and cardiovascular events ( ischemic stroke, myocardial infarction, systemic embolism, or vascular death). RESULTS: The analysis included 8932 patients and 17 685 years of observation from 12 trials. Patient age increased risk of ischemic stroke (adjusted hazard ratio per decade increase 1.45; 95% CI, 1.26 to 1.66), serious bleeding (1.61; 1.47 to 1.77), and cardiovascular events (1.43; 1.33 to 1.53). Compared with placebo, OAC and AP significantly reduced the risk of ischemic stroke (OAC, 0.36; 0.29 to 0.45; AP, 0.81; 0.72 to 0.90) and cardiovascular outcomes (OAC, 0.59; 0.52 to 0.66; AP, 0.81; 0.75 to 0.88), whereas OAC increased risk of serious bleeding (1.56; 1.03 to 2.37). The relative benefit of OAC versus placebo or AP did not vary by patient age for any outcome. Compared with placebo, the relative benefit of AP for preventing ischemic stroke decreased significantly as patients aged (P=0.01). CONCLUSIONS: As patients with atrial fibrillation age, the relative efficacy of AP to prevent ischemic stroke appears to decrease, whereas it does not change for OAC. Because stroke risk increases with age, the absolute benefit of OAC increases as patients get older.
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Authors | Carl van Walraven, Robert G Hart, Stuart Connolly, Peter C Austin, Jonathan Mant, F D Richard Hobbs, Peter J Koudstaal, Palle Petersen, Francisco Perez-Gomez, J Andre Knottnerus, Beppie Boode, Michael D Ezekowitz, Daniel E Singer |
Journal | Stroke
(Stroke)
Vol. 40
Issue 4
Pg. 1410-6
(Apr 2009)
ISSN: 1524-4628 [Electronic] United States |
PMID | 19182090
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
- Anticoagulants
- Platelet Aggregation Inhibitors
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Topics |
- Age Distribution
- Aged
- Aged, 80 and over
- Anticoagulants
(therapeutic use)
- Atrial Fibrillation
(epidemiology)
- Brain Ischemia
(epidemiology, prevention & control)
- Cerebral Hemorrhage
(epidemiology, prevention & control)
- Databases, Factual
- Female
- Follow-Up Studies
- Humans
- Male
- Multivariate Analysis
- Platelet Aggregation Inhibitors
(therapeutic use)
- Randomized Controlled Trials as Topic
- Risk Factors
- Stroke
(epidemiology, prevention & control)
- Thrombosis
(drug therapy, epidemiology, prevention & control)
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