Thromboembolic and bleeding outcomes in patients with atrial fibrillation and valvular heart disease: A descriptive nationwide cohort study

Melgaard, Line; Jensen, Mogens Krogh; Overvad, Thure Filskov; Larsen, Torben Bjerregaard; Lip, Gregory Y.H.; Nielsen, Peter Brønnum

doi:10.1111/ijcp.13589

Cited by 10 publications

(9 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, in the literature there is no comparison between patients with EHRA type 2 and those with non-valvular AF regarding this score. The high anticoagulation rate in group 1 of this study is also similar to the recent published study, in which the rates were 62.5% for patients with moderate to severe mitral stenosis and 100% for those with mechanical replacement of the prosthetic valve [18]. On the other hand, the anticoagulation rate in group 2 was lower than in the aforementioned study, which showed rates between 50.8% and 67.1% for patients in the EHRA type 2 categorization.…”

Section: Discussionsupporting

confidence: 88%

“…Nationwide cohort study with a large sample of patients with valvular heart disease and AF, but with 90% of patients with EHRA type 2, demonstrated a rate of 14.6% and 18.6% of thromboembolism in patients with EHRA type 1 and EHRA type 2, respectively [17]. A study from the same group showed that the rate of previous thromboembolism ranged from 10.0% to 14.6% between patients in both groups [18]. The higher rate of thromboembolism in our study can be explained by the higher proportion of patients with moderate to severe mitral stenosis in group 1, which was 89.5%, compared to the rate of 29.2% in the study mentioned above.…”

Section: Discussionmentioning

confidence: 95%

See 1 more Smart Citation

Clinical Profile of Patients with Atrial Fibrillation According to EHRA (Evaluated Heart Valves, Rheumatic or Artificial) Categorization in A Middle-Income Country

et al. 2022

View full text Add to dashboard Cite

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in clinical practice. As of 2017, a functional EHRA (Evaluated Heart valves, Rheumatic or Artificial) categorization was proposed to replace the terms valvular and non-valvular AF. In our country, despite the incidence of rheumatic valve heart disease, studies on this new categorization are scarce Objective: to assess the clinical profile of patients (pts) with AF, using the EHRA categorization as a parameter. Methods: this is a prospective, observational and cross-sectional study with 475 pts with AF from a university institution. Clinical and laboratory evaluations were carried out, as well as the calculation of risk scores for embolism, bleeding and renal function. Statistical analysis was performed by non-parametric tests, in addition to the chi-square test. Results: the pts were divided into 3 groups, according to the EHRA categorization: EHRA 1, with 144 pts, with mitral stenosis or mechanical prosthesis; EHRA 2, with 46 pts with other valvular heart diseases; and EHRA 3, with 285 pts, without valvular heart disease. Mean ages were 51.5; 57.6 and 62.9 years, respectively (p<0.0001). The proportions of women were 75%; 52.1% and 40.7% (p<0.0001). The presentation of the AF was permanent in 68.1%; 60.9%; 52.3% of pts (p=0.008) and 86.0%; 47.8% and 53.3% of pts were using oral anticoagulants, respectively (p<0.0001). The means of left ventricular ejection fraction were 0.58; 0.57 and 0.46; of left atrium were 55.9; 52.5 and 48.1 mm; ATRIA score of 1.4; 1.3 and 2.1; and the glomerular filtration rate of 91.7; 91.1 and 75.0 mL/min/1.73m², respectively (p<0.0001). There was no difference among groups regarding blood pressure and heart rate at study entry and regarding the history of embolism. Conclusions: pts from the EHRA 1 categorization were younger, with a higher proportion of women, permanent AF and use of oral anticoagulants. Systolic dysfunction predominated in those without valve disease, who also had a higher bleeding score and greater impairment of renal function.

show abstract

Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 95%

Clinical Profile of Patients with Atrial Fibrillation According to EHRA (Evaluated Heart Valves, Rheumatic or Artificial) Categorization in A Middle-Income Country

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Only a few post hoc sub‐analyses of the existing randomized, controlled trials have examined patients with both AF and VHD, and the proportion of patients with aortic stenosis was underrepresented (6%–12%), 12 , 19 , 20 , 21 despite aortic stenosis being one of the most prevalent VHDs in recent patients with AF and VHD (17%–62% with aortic stenosis). 2 , 22 , 23 , 24 Consequently, the effectiveness and safety of NOAC versus warfarin in AF patients with aortic stenosis has not been specifically investigated, although guidelines currently allow for use of NOACs in AF patients with aortic stenosis (and without a mechanical heart valve or concomitant moderate/severe mitral stenosis). 25 , 26 …”

mentioning

confidence: 99%

Effectiveness and Safety of NOAC Versus Warfarin in Patients With Atrial Fibrillation and Aortic Stenosis

Melgaard

Overvad

Jensen

et al. 2021

JAHA

Self Cite

View full text Add to dashboard Cite

Background Guideline recommendations on the use of non–vitamin K antagonist oral anticoagulants (NOACs) in atrial fibrillation (AF) patients with aortic stenosis are based on studies including a low number of patients with aortic stenosis. The aim of this study was to estimate the effects of NOAC versus warfarin on thromboembolism and major bleeding among AF patients with aortic stenosis. Methods and Results We emulated a target trial using observational data from Danish nationwide registries between 2013 and 2018. Thromboembolism was defined as a hospital diagnosis of ischemic stroke and/or systemic embolism, and major bleeding was defined as a hospital diagnosis of intracranial bleeding, gastrointestinal bleeding, or major or clinically relevant bleeding in other anatomic sites. Treatment effect estimates were based on an intention‐to‐treat and per‐protocol approach. A total of 3726 patients with AF and aortic stenosis claimed a prescription for either a NOAC (2357 patients) or warfarin (1369 patients) and met the eligibility criteria for the trial. During 3 years of follow‐up, the adjusted hazard ratios for thromboembolism and major bleeding were 1.62 (95% CI, 1.08–2.45) and 0.73 (0.59–0.91) for NOAC compared with warfarin in the intention‐to‐treat analyses. Similar results were observed in the per‐protocol analyses. Conclusions In this observational study, we observed a higher risk of thromboembolism but a lower risk of major bleeding for treatment with NOACs compared with warfarin in patients with AF and aortic stenosis. This observation needs confirmation in large randomized trials in these commonly encountered patients.

show abstract

“… 1 It is an independent cause of mortality and morbidity associated with thromboembolic and bleeding events, irrespective of underlying cardiac rhythm. 4 , 5 AF patients have historically been dichotomized as “valvular” AF or “nonvalvular” AF. However, clinical definitions of these terms have been conflicting, causing confusion among researchers and practitioners.…”

Section: Introductionmentioning

confidence: 99%

Thromboembolism and Major Bleeding in Patients with Atrial Fibrillation and EHRA Type 2 Valvular Heart Disease: The Jordan Atrial Fibrillation (JoFib) Study

Al-Najar¹,

Al-Nusair²,

Alrabadi³

et al. 2023

VHRM

View full text Add to dashboard Cite

Aim The risks of thromboembolism and major bleeding in atrial fibrillation (AF) patients were assessed according to the “Evaluated Heartvalves, Rheumatic or Artificial” (EHRA) classification. Additionally, the safety and efficacy of vitamin K antagonists (VKAs) and non-VKA oral anticoagulants (NOACs) were compared in AF patients with EHRA type 2 valvular heart disease (VHD) versus those with no VHD. Methods AF patients enrolled in the “Jordan Atrial Fibrillation (JoFib)” study were followed up for thromboembolic events and major bleeding at 30, 180, and 365 days. Patients in the EHRA type 2 VHD and non-VHD groups were sub-grouped to compare different OACs. Results 2020 AF patients were recruited. The thromboembolic risk was higher in EHRA type 2 VHD patients compared to non-VHD controls. Major bleeding also occurred at higher rates in EHRA type 2 patients. In addition, NOACs were more effective in preventing thromboembolic events than VKAs and non-anticoagulation in EHRA type 2 VHD patients. Furthermore, EHRA type 2 VHD patients taking rivaroxaban had significantly less thromboembolic risk than their non-anticoagulated counterparts. At the same time, apixaban and warfarin did not significantly lower the risk of thromboembolism compared to non-anticoagulation. Conclusion AF patients with EHRA type 2 VHD are at significant risk of thromboembolism and major bleeding. Furthermore, NOACs were more effective than VKAs in preventing thromboembolic events in this group of patients without conferring an added risk of major bleeding. Moreover, rivaroxaban appears to be particularly efficacious.

show abstract

Thromboembolic and bleeding outcomes in patients with atrial fibrillation and valvular heart disease: A descriptive nationwide cohort study

Cited by 10 publications

References 41 publications

Clinical Profile of Patients with Atrial Fibrillation According to EHRA (Evaluated Heart Valves, Rheumatic or Artificial) Categorization in A Middle-Income Country

Clinical Profile of Patients with Atrial Fibrillation According to EHRA (Evaluated Heart Valves, Rheumatic or Artificial) Categorization in A Middle-Income Country

Effectiveness and Safety of NOAC Versus Warfarin in Patients With Atrial Fibrillation and Aortic Stenosis

Thromboembolism and Major Bleeding in Patients with Atrial Fibrillation and EHRA Type 2 Valvular Heart Disease: The Jordan Atrial Fibrillation (JoFib) Study

Contact Info

Product

Resources

About