Author + information
- Anjani Golive,
- Heidi May,
- Tami Bair,
- Victoria Jacobs,
- Brian Crandall,
- Michael J. Cutler,
- John Day,
- Charles Mallender,
- Jeffrey S. Osborn,
- Jonathan Weiss and
- T. Jared Bunch
Background: Stroke risk is a significant concern in patients with atrial fibrillation (AF). European Society of Cardiology guidelines advocated initiation of anticoagulation for low risk patients (CHADS2 ≤1). We sought to define the long-term impact of anticoagulant and antiplatelet therapy use in AF patients at low risk of stroke (CHADS2 0-1).
Methods: A total of 56,764 patients diagnosed with AF with a CHADS2 score of 0 and 1. Antithrombotic therapy was defined at aspirin, clopidogrel or warfarin therapy initiated within 6 months of AF diagnosis. We compared the long-term outcomes for all-cause mortality, cerebrovascular accident (CVA), transient ischemic attack (TIA), and major bleed among patients receiving either antiplatelet or warfarin therapies.
Results: Average age of the population was 67.0±14.1 years and 56.6% were male. Antithrombotic therapy included 1164 on warfarin, 1,802 on clopidogrel, and 9,682 on aspirin. At 5 years in the CHADS2 0 and 1 groups, 18.5% and 37.8% had died, 1.7% and 3.4% had a stroke, 2.2 and 3.2% had a TIA, 14% and 12.5% had a major bleed (p<0.0001 for all). At 3- and 5-years (Figure), stroke, TIA, and major bleed rates were higher with both antiplatelet and anticoagulation therapies compared to no treatment (p<0.0001 all). Event rates with warfarin were lower than those observed with antiplatelet therapies.
Conclusions: In this large community based study, in low risk AF patients with a CHADS2 scores ≤1, use of aspirin, clopidogrel, and warfarin did not lower stroke risk at 5 years.
Moderated Poster Contributions
Arrhythmias and Clinical EP Moderated Poster Theater, Poster Hall, Hall C
Friday, March 17, 2017, 11:45 a.m.-11:55 a.m.
Session Title: Atrial Fibrillation, Anticoagulation and Novel Device Therapies
Abstract Category: 4. Arrhythmias and Clinical EP: Basic
Presentation Number: 1134M-17
- 2017 American College of Cardiology Foundation