0492395 - ÚI 2019 GB eng A - Abstrakt
Rohla, M. - Weiss, T. W. - Pecen, Ladislav - Rincon Diaz, L. M. - Zamorano, J. - Schilling, R. J. - Kotecha, D. - Lucerna, M. - Huber, K. - De Caterina, R. - Kirchhof, P.
Residual Stroke Risk of Anticoagulated Patients with Atrial Fibrillation: PREFER in AF European Registry.
European Heart Journal. Roč. 38, Suppl. 1 (2017), ehx504.P4604. ISSN 0195-668X. E-ISSN 1522-9645.
[Congress of the European Society of Cardiology 2017. 26.08.2017-30.08.2017, Barcelona]
Klíčová slova: atrial fibrillation * stroke risk
https://esc365.escardio.org/Congress/ESC-CONGRESS-2017/Poster-session-5-Registries-and-cost-of-treatment/159681-residual-stroke-risk-of-anticoagulated-patients-with-atrial-fibrillation-prefer-in-af-european-registry

BACKGROUND: Stroke prevention is a major goal in the treatment of AF. The residual stroke risk in anticoagulated patients should be addressed as part of an integrated management approach, particularly when modifiable risk factors are involved. METHODS AND RESULTS: We sought to identify risk factors for stroke and bleeding by analysing validated risk stratifications schemes and their components in an anticoagulated cohort of the PREFER in AF European registry. Between 2012–2013, 5310 anticoagulated AF patients were enrolled, of whom 40% were female, mean age was 72±10, and mean CHA2DS2-VASc and HAS-BLED scores were 3.5±1.7 and 2.0±1.1, respectively. Stroke or systemic embolic events and major bleedings occurred at an annual rate of 2.4% (95% CI 2.0–2.9) and 2.8% (95% CI 2.4–3.3), respectively. A best-performing cluster of 6 residual stroke risk factors outperformed the established scores, of which abnormal liver function, labile international normalised ratio and drug use (antiplatelet- or non-steroidal anti-inflammatory drugs) were potentially modifiable. For each single point decrease on an adjusted modifiable bleeding risk scale we observed a 31% lower risk for major bleeding events (OR 0.69,95% CI 0.64–0.74). When applied to evaluate residual stroke risk, there was a 25% lower event rate per point decrease (OR 0.75,95% CI 0.69–0.81). The HAS-BLED, CHADS2, and CHA2DS2-VASc scores performed statistically similarly regarding residual stroke risk prediction. CONCLUSION: In an anticoagulated AF cohort, the overlap of residual stroke and bleeding risk was substantial. Reduction of modifiable bleeding risk factors appears a reasonable approach to minimise the risk of both stroke and bleeding in anticoagulated AF patients.
Trvalý link: http://hdl.handle.net/11104/0285954