Key result
Discontinuation of oral anticoagulation for ≥7 days was associated with higher risks of all-cause death (HR 1.62), stroke/systemic embolism (HR 2.21), and myocardial infarction (HR 1.85).
Why the study?
While oral anticoagulation reduces stroke and systemic embolism in atrial fibrillation, the impact of discontinuing oral anticoagulation is less well documented.
Does discontinuation of oral anticoagulation for ≥7 consecutive days increase the risk of mortality, stroke/systemic embolism, and myocardial infarction in newly diagnosed patients with atrial fibrillation?
Cohort (n=23,882)
Yes
Does discontinuation of oral anticoagulation for ≥7 consecutive days increase the risk of mortality, stroke/systemic embolism, and myocardial infarction in newly diagnosed patients with atrial fibrillation?
Hazard Ratio: 1.62 (95% CI 1.25–2.09)
Discontinuation of oral anticoagulation for 7 or more consecutive days in patients with atrial fibrillation is associated with significantly increased risks of mortality, stroke, and myocardial infarction.
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.
No takes yet. Share an insight, caveat, or question.
Cools et al. (2021) conducted a cohort in Newly diagnosed atrial fibrillation (n=23,882). Oral anticoagulation discontinuation (≥7 consecutive days) vs. No discontinuation of oral anticoagulation was evaluated on All-cause death (HR 1.62, 95% CI 1.25-2.09). Discontinuation of oral anticoagulation for ≥7 days was associated with higher risks of all-cause death (HR 1.62), stroke/systemic embolism (HR 2.21), and myocardial infarction (HR 1.85).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: