Continued Anticoagulation in Resolved AFib May Help Reduce Stroke Risk

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The researchers suggest that continued anticoagulation may benefit patients with resolved atrial fibrillation.
The researchers suggest that continued anticoagulation may benefit patients with resolved atrial fibrillation.

An analysis of 2 retrospective studies published in BMJ suggests that patients with a history of atrial fibrillation (AF) are at a higher risk for stroke or transient ischemic attack (TIA) compared with individuals with unresolved AF or those without a clinical AF history.

The Health Improvement Network provided data on patients who had received care from general practices in the United Kingdom during a 16-year period. Investigators conducted 2 retrospective cohort studies to determine whether patients with resolved AF (n=11,159) were at an increased risk for stroke or TIA and all-cause mortality compared with matched controls with unresolved AF (n=15,059) or no AF (n=22,266).

Individuals with resolved AF were generally younger compared with individuals with AF (median age, 69.7 vs 74.2, respectively). Following adjustment for age, sex, body mass index, smoking status, alcohol consumption, and comorbidities, the adjusted incidence rate ratios for stroke or TIA were 0.76 (95% CI, 0.67-0.85; P <.001) for patients with resolved AF vs controls with unresolved AF and 1.63 (95% CI, 1.46-1.83; P <0.001) for patients with resolved AF vs controls without AF. Additionally, the adjusted incidence rate ratios for mortality were 0.60 (95% CI, 0.56-0.65; P <.001) for patients with resolved AF vs controls with unresolved AF and 1.13 (95% CI, 1.06-1.21; P <0.001) for patients with resolved AF vs controls without AF.

The findings from the study may be limited to generalization across UK general practices only. Additionally, the investigators were unable to include ethnicity as a covariate, further limiting the analysis to the general population rather than providing a more conclusive finding across different ethnic groups.

Patients with resolved AF may “benefit from continued anticoagulant prophylaxis, but treatment rates in this group are extremely low.” The investigators recommend “that national and international guidelines [be] updated to advocate continued use of anticoagulant treatment in patients with resolved atrial fibrillation.”

Reference

Adderley NJ, Nirantharakumar K, Marshall T. Risk of stroke and transient ischaemic attack in patients with a diagnosis of resolved atrial fibrillation: retrospective cohort studies. BMJ. 2018;361:k1717.

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