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Risks associated with discontinuation of oral anticoagulation in newly diagnosed patients with atrial fibrillation: Results from the GARFIELD‐AF Registry
Author(s) -
Cools Frank,
Johnson Dana,
Camm Alan J.,
Bassand JeanPierre,
Verheugt Freek W. A.,
Yang Shu,
Tsiatis Anastasios,
Fitzmaurice David A.,
Goldhaber Samuel Z.,
Kayani Gloria,
Goto Shinya,
Haas Sylvia,
Misselwitz Frank,
Turpie Alexander G. G.,
Fox Keith A. A.,
Pieper Karen S.,
Kakkar Ajay K.
Publication year - 2021
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/jth.15415
Subject(s) - discontinuation , medicine , atrial fibrillation , stroke (engine) , hazard ratio , myocardial infarction , warfarin , lower risk , rivaroxaban , cardiology , surgery , confidence interval , mechanical engineering , engineering
Background Oral anticoagulation (OAC) in atrial fibrillation (AF) reduces the risk of stroke/systemic embolism (SE). The impact of OAC discontinuation is less well documented. Objective Investigate outcomes of patients prospectively enrolled in the Global Anticoagulant Registry in the Field‐Atrial Fibrillation study who discontinued OAC. Methods Oral anticoagulation discontinuation was defined as cessation of treatment for ≥7 consecutive days. Adjusted outcome risks were assessed in 23 882 patients with 511 days of median follow‐up after discontinuation. Results Patients who discontinued ( n = 3114, 13.0%) had a higher risk (hazard ratio [95% CI]) of all‐cause death (1.62 [1.25–2.09]), stroke/systemic embolism (SE) (2.21 [1.42–3.44]) and myocardial infarction (MI) (1.85 [1.09–3.13]) than patients who did not, whether OAC was restarted or not. This higher risk of outcomes after discontinuation was similar for patients treated with vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs) ( p for interactions range = 0.145–0.778). Bleeding history (1.43 [1.14–1.80]), paroxysmal vs. persistent AF (1.15 [1.02–1.29]), emergency room care setting vs. office (1.37 [1.18–1.59]), major, clinically relevant nonmajor, and minor bleeding (10.02 [7.19–13.98], 2.70 [2.24–3.25] and 1.90 [1.61–2.23]), stroke/SE (4.09 [2.55–6.56]), MI (2.74 [1.69–4.43]), and left atrial appendage procedures (4.99 [1.82–13.70]) were predictors of discontinuation. Age (0.84 [0.81–0.88], per 10‐year increase), history of stroke/transient ischemic attack (0.81 [0.71–0.93]), diabetes (0.88 [0.80–0.97]), weeks from AF onset to treatment (0.96 [0.93–0.99] per week), and permanent vs. persistent AF (0.73 [0.63–0.86]) were predictors of lower discontinuation rates. Conclusions In GARFIELD‐AF, the rate of discontinuation was 13.0%. Discontinuation for ≥7 consecutive days was associated with significantly higher all‐cause mortality, stroke/SE, and MI risk. Caution should be exerted when considering any OAC discontinuation beyond 7 days.