Antithrombotic Therapy and First Myocardial Infarction in Patients With Atrial Fibrillation

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  • Christina J-Y Lee, Department of Health Science and Technology, Aalborg University, and Department of Clinical Epidemiology and Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark. Electronic address: cjilee@outlook.com.
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  • Jannik L Pallisgaard, Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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  • Jonas Bjerring Olesen, Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
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  • Nicholas Carlson, Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark; Danish Heart Foundation, Copenhagen, Denmark; Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark.
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  • Morten Lamberts, The Heart Centre, Rigshospitalet University Hospital, Copenhagen, 2100, Denmark.
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  • Gunnar H Gislason, Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Danish Heart Foundation, Copenhagen, Denmark.
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  • Christian Torp-Pedersen, Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark; Institute of Health Science and Technology, Aalborg University, Denmark; Clinical Institute, Aalborg University, Denmark.
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  • Axel Brandes, Department of Cardiology, Odense University Hospital, Denmark.
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  • Steen E Husted
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  • Søren P Johnsen
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  • Morten L Hansen, Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark; Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Cardiology, Zealand University Hospital, Roskilde, Denmark.

BACKGROUND: Patients with atrial fibrillation (AF) have increased risk of thromboembolic events such as stroke and myocardial infarction (MI). Although it has been established that the efficacy of anticoagulation is superior to that of antiplatelet agents for stroke prophylaxis in AF, the optimal antithrombotic treatment remains uncertain for primary protection against MI.

OBJECTIVES: The authors investigated the incidence of first-time MI in patients with AF according to antithrombotic treatment and estimated the risk of stroke and bleeding.

METHODS: Subjects with first-time AF diagnosed from 1997 to 2012 without history of coronary artery disease were identified using Danish nationwide administrative registries. Subjects were divided into time varying exposure groups according to antithrombotic treatment. The relative risks of outcomes were estimated by Poisson regression models.

RESULTS: A total of 71,959 patients (median 75 years of age; females: 47%). At baseline, 37,539 patients (52%) were treated with vitamin K antagonist (VKA) monotherapy, 25,458 (35%) with acetylsalicylic acid (ASA) monotherapy and 8,962 (13%) with dual-therapy (VKA + ASA). The incidence of MI was 3% (n = 2,275). Relative to the VKA-treated group, the associated risk of MI was significantly higher for ASA (incidence rate ratio [IRR]: 1.54; 95% confidence interval [CI]: 1.40 to 1.68) and dual-therapy (IRR: 1.22; 95% CI: 1.06 to 1.40). The bleeding risk was significantly higher for dual-therapy (IRR: 1.93; 95% CI: 1.81 to 2.07). The risk of stroke relative to that of VKA therapy was significantly higher for both ASA (IRR: 2.00; 95% CI: 1.88 to 2.12) and dual-therapy (IRR: 1.30; 95% CI: 1.18 to 1.43).

CONCLUSIONS: VKA monotherapy in patients with AF was associated with a lower risk of first-time MI and stroke than ASA monotherapy. Combination of ASA and VKA therapy was not associated with a lower risk of MI but was associated with increased bleeding risk.

Original languageEnglish
JournalJournal of the American College of Cardiology
Volume69
Issue24
Pages (from-to)2901-2909
Number of pages9
ISSN0735-1097
DOIs
Publication statusPublished - 20 Jun 2017

    Research areas

  • Aged, Aged, 80 and over, Atrial Fibrillation, Denmark, Female, Fibrinolytic Agents, Follow-Up Studies, Humans, Incidence, Male, Middle Aged, Myocardial Infarction, Registries, Retrospective Studies, Risk Factors, Stroke, Treatment Outcome, Journal Article, Multicenter Study

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