Abstract
Background
We aimed to investigate whether history of venous thromboembolism should be considered
a prognostic factor for future thromboembolic events in patients with atrial fibrillation.
Methods
This was a nationwide cohort study of patients with incident atrial fibrillation from
2000-2017, defined and characterized using Danish health registries. Cox regression
analyses were used to calculate hazard ratios and 95% confidence intervals for the
outcomes ischemic stroke or systemic embolism, and ischemic stroke, systemic embolism,
or venous thromboembolism, according to history of venous thromboembolism. Analyses
were adjusted for components of the CHA2DS2-VASc score and time-varying use of oral anticoagulation.
Results
The study included 246,313 patients with incident atrial fibrillation, of which 6,516
(2.6%) had previous venous thromboembolism. Patients with previous venous thromboembolism
carried an overall similar adjusted risk of ischemic stroke or systemic embolism compared
with patients without previous venous thromboembolism (reference; hazard ratio 0.99;
95% confidence interval, 0.90-1.09). When analyzing a composite thromboembolic outcome
of ischemic stroke, systemic embolism, or venous thromboembolism, patients with previous
venous thromboembolism were at high-risk (hazard ratio 1.76; 95% confidence interval,
1.64-1.90). Similar conclusions were drawn when stratifying by venous thromboembolism
subtype, and when restricting to patients with low CHA2DS2-VASc scores or the non-anticoagulated subset of the study population.
Conclusion
Patients with atrial fibrillation and previous venous thromboembolism carried similar
risk of ischemic stroke or systemic embolism compared with patients with atrial fibrillation
without previous venous thromboembolism. Nonetheless, patients with previous venous
thromboembolism remain a high-risk population due to an excess risk of future venous
thromboembolism. Patients and physicians should keep this excess thromboembolic risk
in mind when weighing the expected risks and benefits of oral anticoagulation in patients
with atrial fibrillation.
Keywords
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Article info
Publication history
Published online: July 03, 2020
Footnotes
Funding: None.
Conflict of Interest: GYHL has served as a consultant for Bayer/Janssen, BMS/Pfizer, Medtronic, Boehringer Ingelheim, Novartis, Verseon, and Daiichi Sankyo, and as speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi Sankyo. No fees are directly received personally. IEA has received speaking fees from Pfizer and Bayer. TBL has served as an investigator for Janssen Scientific Affairs, LLC and Boehringer Ingelheim, and has been on speaker bureaus for Bayer, BMS/Pfizer, Roche Diagnostics, Boehringer Ingelheim, and Takeda Pharma.
This study was presented virtually as an abstract at American College of Cardiology 2020, Chicago, IL, March 28-30, 2020.
Authorship: All authors had access to the data and a role in writing this manuscript. TFO and FS had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. TFO, FS, MS, TBL, IEA, and GYHL contributed substantially to the study design, data analysis and interpretation, and revising the manuscript for important intellectual content. TFO is the guarantor.
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© 2020 Elsevier Inc. All rights reserved.
