Impact of Previous Stroke on Clinical Outcome in Elderly Patients With Nonvalvular Atrial Fibrillation: ANAFIE Registry.

Abstract

BACKGROUND:

We determined the long-term event incidence among elderly patients with nonvalvular atrial fibrillation in terms of history of stroke/transient ischemic attack (TIA) and oral anticoagulation.

METHODS:

Patients aged ≥75 years with documented nonvalvular atrial fibrillation enrolled in the prospective, multicenter, observational All Nippon Atrial Fibrillation in the Elderly Registry between October 2016 and January 2018 were divided into 2 groups according to history of stroke/TIA. The primary end point was the occurrence of stroke/systemic embolism within 2 years, and secondary end points were major bleeding and all-cause death within 2 years. Cox models were used to determine whether there was a difference in the hazard of each end point in patients with/without history of stroke/TIA, and in ischemic stroke/TIA survivors taking direct oral anticoagulants versus those taking warfarin.

RESULTS:

Of 32 275 evaluable patients (13 793 women [42.7%]; median age, 81.0 years), 7304 (22.6%) had a history of stroke/TIA. The patients with previous stroke/TIA were more likely to be male and older and had higher hazard rates of stroke/systemic embolism (adjusted hazard ratio, 2.25 [95% CI, 1.97-2.58]), major bleeding (1.25, 1.05-1.49), and all-cause death (1.13, 1.02-1.24) than the other groups. Of 6446 patients with prior ischemic stroke/TIA, 4393 (68.2%) were taking direct oral anticoagulants and 1668 (25.9%) were taking warfarin at enrollment. The risk of stroke/systemic embolism was comparable between these 2 groups (adjusted hazard ratio, 0.90 [95% CI, 0.71-1.14]), while the risk of major bleeding (0.67, 0.48-0.94), intracranial hemorrhage (0.57, 0.39-0.85), and cardiovascular death (0.71, 0.51-0.99) was lower among those taking direct oral anticoagulants.

CONCLUSIONS:

Patients aged ≥75 years with nonvalvular atrial fibrillation and previous stroke/TIA more commonly had subsequent ischemic and hemorrhagic events than those without previous stroke/TIA. Among patients with previous ischemic stroke/TIA, the risk of hemorrhagic events was lower in patients taking direct oral anticoagulants compared with warfarin.

REGISTRATION:

URL: https://www.

CLINICALTRIALS:

gov; Unique Identifier: UMIN000024006.

• Authors: Takeshi Yoshimoto, Kazunori Toyoda, Masafumi Ihara, Hiroshi Inoue, Takeshi Yamashita, Shinya Suzuki, Masaharu Akao, Hirotsugu Atarashi, Takanori Ikeda, Ken Okumura, Yukihiro Koretsune, Wataru Shimizu, Hiroyuki Tsutsui, Atsushi Hirayama, Masahiro Yasaka, Hirofumi Maruyama, Satoshi Teramukai, Tetsuya Kimura, Yoshiyuki Morishima, Atsushi Takita, Takenori Yamaguchi
• Journal: Stroke (Stroke) Vol. 53 Issue 8 Pg. 2549-2558 (08 2022) ISSN: 1524-4628 [Electronic] United States
• PMID: 35440169 (Publication Type: Journal Article, Multicenter Study)

Chemical References

• Anticoagulants
• Warfarin

Topics

• Administration, Oral
• Aged
• Aged, 80 and over
• Anticoagulants (adverse effects)
• Atrial Fibrillation (complications, drug therapy, epidemiology)
• Embolism (complications)
• Female
• Hemorrhage (chemically induced)
• Humans
• Ischemic Attack, Transient (epidemiology)
• Ischemic Stroke
• Male
• Prospective Studies
• Registries
• Stroke (drug therapy)
• Treatment Outcome
• Warfarin (adverse effects)