Open AccessThromboembolic risk and effect of oral anticoagulation according to atrial fibrillation patterns: A systematic review and meta‐analysis
Author(s) -
Lilli Alessio,
Di Cori Andrea,
Zacà Valerio
Publication year - 2017
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22701
Subject(s) - medicine , atrial fibrillation , stroke (engine) , incidence (geometry) , confidence interval , meta analysis , population , embolism , thromboembolic stroke , relative risk , prospective cohort study , mechanical engineering , physics , environmental health , optics , engineering
Oral anticoagulation ( OAC ) is recommended in both paroxysmal atrial fibrillation ( pxAF ) and nonparoxysmal AF (non‐ pxAF ), but disagreement exists in classes of recommendation. Data on incidence/rate of stroke in pxAF are conflicting, and OAC is often underused in this population. The objectives of the meta‐analysis were to investigate different impact on outcomes of pxAF and non‐ pxAF , with and without OAC . Two reviewers searched for prospective studies on risk of stroke and systemic embolism ( SE ) in pxAF and non‐ pxAF , with and without OAC . Quality of evidence was assessed according to GRADE approach. Stroke combined with SE was the main outcome. Meta‐regression was performed to evaluate OAC effect on stroke and SE incidence rate. We identified 18 studies. For a total of 239 528 patient‐years of follow‐up. The incidence rate of stroke/ SE was 1.6% (95% confidence interval [ CI ]: 1.3%‐2.0%) in pxAF and 2.3% (95% CI : 2.0%‐2.7%) in non‐ pxAF . Paroxysmal AF was associated with a lower risk of overall thromboembolic ( TE ) events (risk ratio: 0.72, 95% CI : 0.65‐0.80, P < 0.00001) compared with non‐ pxAF . In both groups, the annual rate of TE events decreased as proportion of patients treated with OAC increased. Non‐ pxAF showed a reduction from 3.7% to 1.7% and pxAF from 2.5% to 1.2%. Major bleeding rates did not differ among groups. Stroke/ SE risk is significantly lower, although clinically meaningful, in pxAF . OAC consistently reduces TE event rates across any AF pattern. As a whole, these data provide the evidence to warrant OAC irrespective of the AF pattern in most (virtually all) patients.