TY - JOUR
T1 - Impact of Previous Stroke on Clinical Outcome in Elderly Patients with Nonvalvular Atrial Fibrillation
T2 - ANAFIE Registry
AU - Yoshimoto, Takeshi
AU - Toyoda, Kazunori
AU - Ihara, Masafumi
AU - Inoue, Hiroshi
AU - Yamashita, Takeshi
AU - Suzuki, Shinya
AU - Akao, Masaharu
AU - Atarashi, Hirotsugu
AU - Ikeda, Takanori
AU - Okumura, Ken
AU - Koretsune, Yukihiro
AU - Shimizu, Wataru
AU - Tsutsui, Hiroyuki
AU - Hirayama, Atsushi
AU - Yasaka, Masahiro
AU - Maruyama, Hirofumi
AU - Teramukai, Satoshi
AU - Kimura, Tetsuya
AU - Morishima, Yoshiyuki
AU - Takita, Atsushi
AU - Yamaguchi, Takenori
N1 - Funding Information:
All the following conflicts are outside the submitted work. Yoshimoto reports lecturer’s fees from Nippon Boehringer Ingelheim (NBI) and Takeda. Dr Toyoda reports lecturer’s fees from Daiichi-Sankyo (DS), Bayer, Takeda, and Bristol-Myers Squibb (BMS). Dr Ihara reports lecturer’s fees from DS and Eisai, and grant support from Panasonic, GE Precision Healthcare LLC, BMS, and Shimadzu Corporation. Dr Inoue reports remuneration from DS, Bayer, and BMS. Dr Yamashita reports research funding from DS, BMS, and Bayer, article fees from DS, and BMS, and remuneration from DS, Bayer, Pfizer Japan, BMS, and Ono Pharmaceutical. Dr Suzuki reports research funding from DS, and remuneration from DS and BMS. Dr Akao reports research funding from DS and Bayer, and remuneration from BMS, NBI, Bayer, and DS. Dr Atarashi reports remuneration from DS. Dr Ikeda reports research grants from DS, Medtronic Japan, and Japan Lifeline and honoraria from Ono Pharma, Bayer, DS, BMS, and Pfizer, and was a member of the advisory board for Bayer, BMS, and DS. Dr Okumura reports remuneration from NBI, DS, Johnson & Johnson, and Medtronic. Dr Koretsune reports remuneration from DS, Bayer, and NBI. Dr Shimizu reports research funding from DS, BMS, and NBI, and patent royalties/licensing fees from DS, Pfizer Japan, BMS, Bayer, and NBI. Dr Tsutsui reports research funding from DS, Mitsubishi Tanabe Pharma, NBI, and IQVIA Services Japan, remuneration from DS, Bayer, NBI, Pfizer Japan, Otsuka Pharmaceutical, and Mitsubishi Tanabe Pharma, scholarship funding from DS, Mitsubishi Tanabe Pharma, and Teijin Pharma, and consultancy fee from Novartis Pharma, Pfizer Japan, Bayer, NBI, and Ono Pharmaceutical. Hirayama reports participated in a course endowed by Boston Scientific Japan, and has received research funding from DS and Bayer, and remuneration from Bayer, DS, BMS, NBI, Sanofi, Astellas Pharma, Sumitomo Dainippon Pharma, Amgen Astellas BioPharma, and AstraZeneca, and patent royalties/licensing fees from Toa Eiyo. Dr Yasaka reports research funding from NBI, and remuneration from NBI, DS, Bayer, BMS, Pfizer Japan, and CSL Behring. Dr Teramukai reports research funding from NBI and remuneration from DS, Sanofi, Takeda, Chugai Pharmaceutical, Solasia Pharma, Bayer, Sysmex, Nipro, NapaJen Pharma, Gunze, and Atworking. T. Kimura has stock and is an employee of DS. Dr Morishima and A. Takita are employees of DS. Dr Maruyama reports speaker fees from Eisai, Pfizer, DS, BMS, NBI, and Bayer, and research support from Eisai and DS. Dr Yamaguchi reports acted as an advisory board member of DS and received remuneration from DS, and BMS.
Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/8/1
Y1 - 2022/8/1
N2 - Background: We determined the long-term event incidence among elderly patients with nonvalvular atrial fibrillation in terms of history of stroke/transient ischemic attack (TIA) and oral anticoagulation. Methods: Patients aged ≥75 years with documented nonvalvular atrial fibrillation enrolled in the prospective, multicenter, observational All Nippon Atrial Fibrillation in the Elderly Registry between October 2016 and January 2018 were divided into 2 groups according to history of stroke/TIA. The primary end point was the occurrence of stroke/systemic embolism within 2 years, and secondary end points were major bleeding and all-cause death within 2 years. Cox models were used to determine whether there was a difference in the hazard of each end point in patients with/without history of stroke/TIA, and in ischemic stroke/TIA survivors taking direct oral anticoagulants versus those taking warfarin. Results: Of 32 275 evaluable patients (13 793 women [42.7%]; median age, 81.0 years), 7304 (22.6%) had a history of stroke/TIA. The patients with previous stroke/TIA were more likely to be male and older and had higher hazard rates of stroke/systemic embolism (adjusted hazard ratio, 2.25 [95% CI, 1.97-2.58]), major bleeding (1.25, 1.05-1.49), and all-cause death (1.13, 1.02-1.24) than the other groups. Of 6446 patients with prior ischemic stroke/TIA, 4393 (68.2%) were taking direct oral anticoagulants and 1668 (25.9%) were taking warfarin at enrollment. The risk of stroke/systemic embolism was comparable between these 2 groups (adjusted hazard ratio, 0.90 [95% CI, 0.71-1.14]), while the risk of major bleeding (0.67, 0.48-0.94), intracranial hemorrhage (0.57, 0.39-0.85), and cardiovascular death (0.71, 0.51-0.99) was lower among those taking direct oral anticoagulants. Conclusions: Patients aged ≥75 years with nonvalvular atrial fibrillation and previous stroke/TIA more commonly had subsequent ischemic and hemorrhagic events than those without previous stroke/TIA. Among patients with previous ischemic stroke/TIA, the risk of hemorrhagic events was lower in patients taking direct oral anticoagulants compared with warfarin. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique Identifier: UMIN000024006.
AB - Background: We determined the long-term event incidence among elderly patients with nonvalvular atrial fibrillation in terms of history of stroke/transient ischemic attack (TIA) and oral anticoagulation. Methods: Patients aged ≥75 years with documented nonvalvular atrial fibrillation enrolled in the prospective, multicenter, observational All Nippon Atrial Fibrillation in the Elderly Registry between October 2016 and January 2018 were divided into 2 groups according to history of stroke/TIA. The primary end point was the occurrence of stroke/systemic embolism within 2 years, and secondary end points were major bleeding and all-cause death within 2 years. Cox models were used to determine whether there was a difference in the hazard of each end point in patients with/without history of stroke/TIA, and in ischemic stroke/TIA survivors taking direct oral anticoagulants versus those taking warfarin. Results: Of 32 275 evaluable patients (13 793 women [42.7%]; median age, 81.0 years), 7304 (22.6%) had a history of stroke/TIA. The patients with previous stroke/TIA were more likely to be male and older and had higher hazard rates of stroke/systemic embolism (adjusted hazard ratio, 2.25 [95% CI, 1.97-2.58]), major bleeding (1.25, 1.05-1.49), and all-cause death (1.13, 1.02-1.24) than the other groups. Of 6446 patients with prior ischemic stroke/TIA, 4393 (68.2%) were taking direct oral anticoagulants and 1668 (25.9%) were taking warfarin at enrollment. The risk of stroke/systemic embolism was comparable between these 2 groups (adjusted hazard ratio, 0.90 [95% CI, 0.71-1.14]), while the risk of major bleeding (0.67, 0.48-0.94), intracranial hemorrhage (0.57, 0.39-0.85), and cardiovascular death (0.71, 0.51-0.99) was lower among those taking direct oral anticoagulants. Conclusions: Patients aged ≥75 years with nonvalvular atrial fibrillation and previous stroke/TIA more commonly had subsequent ischemic and hemorrhagic events than those without previous stroke/TIA. Among patients with previous ischemic stroke/TIA, the risk of hemorrhagic events was lower in patients taking direct oral anticoagulants compared with warfarin. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique Identifier: UMIN000024006.
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U2 - 10.1161/STROKEAHA.121.038285
DO - 10.1161/STROKEAHA.121.038285
M3 - Article
C2 - 35440169
AN - SCOPUS:85135282225
SN - 0039-2499
VL - 53
SP - 2549
EP - 2558
JO - Stroke
JF - Stroke
IS - 8
ER -