High risk of ischemic and hemorrhagic events in AF patients with OAC contraindication
Patients With Atrial Fibrillation Who Are Not on Anticoagulant Treatment Due to Increased Bleeding Risk Are Common and Have a High Risk of StrokeLiterature - Redfors B, Gray WA, Lee RJ, et al. - JACC Clinical Electrophysiology 2017; published online ahead of print
- Among AF patients with OAC contraindications, >4 out of 5 had a CHA₂DS₂-VASc score of >1 and 42.9% had a CHA₂DS₂-VASc-score of ≥4.
- The incidence of ischemic and hemorrhagic stroke was 4.1% and 3.6%, respectively, in the overall study cohort and 12.2% and 20.3%, respectively, among patients with a previous cerebral or intracranial hemorrhage.
- Hemorrhagic stroke occurred in 1 out of 5 patients with previous intracranial or intracerebral hemorrhage.
- In the overall study population, the incidence of ischemic stroke increased with increasing CHADS₂ or CHA₂DS₂-VASc scores (P<0.001), and was consistent with current reference rates for a general population of AF patients.
- The risk of hemorrhagic stroke also increased with increasing CHADS₂ /CHA₂DS₂-VASc, but the relationship was less steep than for ischemic stroke.
- For patients with previous intracranial or intracerebral hemorrhage, the incidence of stroke seemed to be unrelated to CHADS₂ or CHA₂DS₂-VASc score.
- The risk of major bleeding in the entire study population was increased with increasing CHA₂DS₂-VASc and was considerably higher than in an OAC-treated general population of AF patients.
- The risk of dying within 1 year was 12.7% for the overall patient cohort and 23.0% for patients with a history of intracerebral or intracranial hemorrhage.
A considerable number of patients with AF are not treated with OAC because of a bleeding-related contraindication, although they are considered to have high stroke risk according to their CHADS₂ or CHA₂DS₂-VASc score. These data show that these OAC-naive patients have a considerably high risk of ischemic and hemorrhagic stroke events, as well as death, and these risks are particularly high in patients with previous intracranial hemorrhage. These results suggest that new ways to prevent stroke are needed in this population.