Key result
Paroxysmal AF was associated with a lower risk of thromboembolic events compared with nonparoxysmal AF (RR 0.72; 95% CI 0.65-0.80; P<0.00001), though oral anticoagulation reduced rates in both groups.
Why the study?
Does oral anticoagulation reduce the risk of stroke and systemic embolism across different patterns of atrial fibrillation (paroxysmal vs nonparoxysmal)?
Meta-Analysis
Does oral anticoagulation reduce the risk of stroke and systemic embolism across different patterns of atrial fibrillation (paroxysmal vs nonparoxysmal)?
Effect estimate: RR 0.72 (95% CI 0.65-0.80)
Absolute Event Rate: 1.6% vs 2.3%
p-value: p=< 0.00001
Although paroxysmal AF carries a lower thromboembolic risk than nonparoxysmal AF, oral anticoagulation consistently reduces event rates in both patterns, supporting its use irrespective of AF pattern.
Supports anticoagulation irrespective of AF pattern; reinforces consensus on benefit across both paroxysmal and nonparoxysmal subtypes.
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.
No takes yet. Share an insight, caveat, or question.
Lilli et al. (2017) conducted a meta-analysis in Atrial fibrillation. Paroxysmal atrial fibrillation vs. Nonparoxysmal atrial fibrillation was evaluated on Stroke combined with systemic embolism (RR 0.72, 95% CI 0.65-0.80, p=< 0.00001). Paroxysmal AF was associated with a lower risk of thromboembolic events compared with nonparoxysmal AF (RR 0.72; 95% CI 0.65-0.80; P<0.00001), though oral anticoagulation reduced rates in both groups.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: