Author + information
- Received February 2, 2017
- Revision received March 29, 2017
- Accepted April 4, 2017
- Published online June 12, 2017.
- Christina J.-Y. Lee, MDa,b,∗ (, )
- Jannik L. Pallisgaard, MDb,c,
- Jonas Bjerring Olesen, MD, PhDb,
- Nicholas Carlson, MDb,d,e,
- Morten Lamberts, MD, PhDf,
- Gunnar H. Gislason, MD, PhDb,c,d,
- Christian Torp-Pedersen, MD, DMSca,
- Axel Brandes, MD, DMScg,
- Steen E. Husted, MDh,
- Søren P. Johnsen, MDi and
- Morten L. Hansen, MD, PhDb,f,j
- aDepartment of Health Science and Technology, Aalborg University, and Department of Clinical Epidemiology and Cardiology, Aalborg University Hospital, Aalborg, Denmark
- bDepartment of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
- cFaculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- dDanish Heart Foundation, Copenhagen, Denmark
- eDepartment of Internal Medicine, Holbaek Hospital, Holbaek, Denmark
- fHeart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- gDepartment of Cardiology, Odense University Hospital, Odense, Denmark
- hDepartment of Medicine, Hospital Unit West, Jutland, Denmark
- iDepartment of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- jDepartment of Cardiology, Zealand University Hospital, Roskilde, Denmark
- ↵∗Address for correspondence:
Dr. Christina Ji-Young Lee, Department of Health Science and Technology, Danish Institut for Medicin og Sundhedsteknologi, Aalborg University, Fredrik Bajers Vej 7 D2, DK-9220 Aalborg East, 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.
This study was supported by a grant from the Department of Cardiology, Gentofte University Hospital and Bristol-Myers Squibb and Pfizer. Dr. Gislason is supported by an unrestricted clinical research scholarship from the Novo Nordisk Foundation. Dr. Pallisgaard has received grants from Boehringer Ingelheim, Bayer, and AstraZeneca; and has received personal fees from Boehringer Ingelheim and Bristol-Myers Squibb. Dr. Olesen has received speaker fees from Bristol-Myers Squibb, Boehringer Ingelheim, and Bayer; and has received funding for research from the Lundbeck Foundation, Bristol-Myers Squibb, and The Capitol Region of Denmark, Foundation for Health Research. Dr. Lamberts has received speaker fees from Bristol-Myers Squibb and Bayer. Dr. Gislason has received research grants from AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, and Pfizer. Dr. Torp-Pedersen has received personal fees and research grants from Bayer; and a research grant from Biotronic. Dr. Brandes has received speaker fees from Bristol-Myers Squibb and Boehringer Ingelheim. Dr. Johnsen is an advisory board member and speaker for Bristol-Myers Squibb, Bayer, Pfizer, Boehringer Ingelheim, and St. Jude; and has received a research grant from Pfizer. Dr. Hansen has received speaker fees from Boehringer Ingelheim, Bayer, and Bristol-Myers Squibb. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 2, 2017.
- Revision received March 29, 2017.
- Accepted April 4, 2017.
- 2017 American College of Cardiology Foundation