Discontinuation of oral anticoagulation in atrial fibrillati
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Atrial fibrillation (AF) is the most common chronic cardiac arrythmia affecting approximately 2%–3% of the population of Europe and the USA. It is associated with a fivefold increased risk of ischaemic stroke (IS) across all ages. Clinical guidelines thus recommended life-long OAC therapy for patients with AF at increased stroke risk. Continuous OAC therapy without interruption is necessary to maintain this benefit.

This study aimed to evaluate associations between oral anticoagulant (OAC) discontinuation and risk of ischaemic stroke (IS) among patients with atrial fibrillation (AF).

Researchers undertook a population-based cohort study with nested case–control analysis using UK primary care electronic health records (IQVIA Medical Research Data-UK) and linked registries from the Region of Southern Denmark (RSD). Patients with AF were followed to identify incident IS cases. Incident IS cases were matched by age and sex to controls.

Results:
-- Researchers identified 616 incident IS cases in the UK and 643 in the RSD. ORs for IS with any OAC discontinuation were 2.99, UK and 2.30, RSD.

-- For vitamin K antagonist discontinuation they were 2.38, UK and 1.83, RSD, and for non-vitamin K antagonist oral anticoagulant discontinuation they were 4.59, UK and 3.37, RSD.

-- ORs were unaffected by time since discontinuation and duration of use.

-- Annually, up to 987 IS cases in the UK and 132 in Denmark could be preventable if OAC therapy is not discontinued.

Conclusively, these results suggest that patients with AF who discontinue OAC therapy have a significant twofold to threefold higher risk of IS compared with those who continue therapy. Addressing OAC discontinuation could potentially result in a significant reduction in AF-attributed IS.

Source: https://heart.bmj.com/content/early/2020/12/10/heartjnl-2020-317887
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