Key result
During 1-year follow-up, all-cause mortality varied by antithrombotic regimen, with higher mortality observed in APT-treated and untreated patients.
Why the study?
Data on antithrombotic treatment among patients with atrial fibrillation in Poland are limited.
Does the choice of antithrombotic therapy affect 1-year mortality and thromboembolic events in patients with atrial fibrillation?
Observational (n=701)
Yes
Does the choice of antithrombotic therapy affect 1-year mortality and thromboembolic events in patients with atrial fibrillation?
Answers are grounded in this paper and cite their sources.
Patients with atrial fibrillation at low stroke risk are often overtreated with anticoagulants, while those treated with antiplatelet therapy alone or no antithrombotic treatment experience higher mortality.
INTRODUCTION: Data on antithrombotic treatment among patients with atrial fibrillation (AF) in Poland are limited. OBJECTIVES: We aimed to describe antithrombotic management within the Polish part of the EUROobservational Research Programme on Atrial Fibrillation General Long-Term Registry. PATIENTS AND METHODS: We analyzed data collected at baseline and at 1‑year follow‑up from 701 Polish patients treated at 25 Polish centers between 2013 and 2016. RESULTS: Any antithrombotic therapy was administered to 94% of patients (vitamin K antagonists [VKAs], 53%; non‑VKA oral anticoagulants [NOACs], 36%; antiplatelet therapy [APT], 4.8%). However, 78% of patients considered as "low‑risk" (CHA2DS2‑VASc = 0 in men or 1 in women) were prescribed oral anticoagulants and 12% were on APT. Independent predictors of NOAC and VKA use were first‑detected AF and device therapy. Predictors of VKA use were lone AF, history of ischemic stroke, and pulmonary embolism or deep vein thrombosis; of NOAC use, permanent AF; of APT use, history of hemorrhagic events and first‑detected or persistent AF; and of no antithrombotic treatment, young age. Incorrect NOAC prescription was more common in the reduced‑dose group than in the full‑dose group (30% vs 7%). During follow‑up, the all‑cause mortality rate was 5.2%, 0.8%, 15%, and 7% (P <0.0001) and the risk of thromboembolic events was 0.4%, 0.5%, 6.2%, and 0% (P = 0.04) in patients on VKA, NOAC, APT, and no treatment, respectively. CONCLUSIONS: Patients with the lowest stroke risk are often overtreated. The choice of proper antithrombotic strategy does not depend solely on factors incorporated in the CHA2DS2‑VASc score. Higher mortality is observed among APT‑treated patients and those without antithrombotic treatment.
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Lodziński et al. (2020) conducted an observational in Atrial fibrillation (n=701). Antithrombotic therapy (VKA, NOAC, APT) vs. No antithrombotic treatment was evaluated on All-cause mortality at 1 year (p=<0.0001). During 1-year follow-up, all-cause mortality varied by antithrombotic regimen, with higher mortality observed in APT-treated and untreated patients.
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