Neurological

Net anticoagulant benefit after stroke in patients aged 66 to 74 years

According to a study recently published in JAMA Cardiology, post-stroke anticoagulation therapy in elderly patients with atrial fibrillation (AF) and non-gender risk factors may result in net clinical benefit.

This retrospective population-based cohort study enrolled 16,351 adults with a new AF diagnosis between the ages of 66 and 74 (median age 70), of whom 51.1% were men. The investigation period extended from April 2007 to March 2017.

All subjects in the study were diagnosed with atrial fibrillation in Ontario, Canada and were given health coverage through the provincial insurance plan. Individuals with prior anticoagulation therapy, heart failure, valvular heart disease, high blood pressure, stroke, diabetes, or vascular disease, or who lived in a long-term care facility were excluded.

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Stroke hospitalization was the primary endpoint. To estimate the 1-year incidence of stroke in those not treated with anticoagulation therapy, the study researchers used a cumulative incidence function. The association between participants’ characteristics and stroke incidence was assessed using Fine-Gray regression, which enabled a model of the estimated 1-year risk of stroke with age. The analysis treated death as a competitive risk.

38.6% (n = 6314) of the study population started anticoagulation therapy in the follow-up period. Among those who did not initiate anticoagulation therapy, the death rate without a stroke was 8.1% (95% CI, 7.7% to 8.5%) and the 1-year incidence of stroke was 1.1% (95% -KI, 1.0% to 1.3). %). No significant association between stroke and gender was found.

However, it has been observed that an increase in the risk of stroke after 1 year with age 66 years (0.7%; 95% CI, 0.5% to 0.9%) to 74 years (1.7%; 95%) % CI, 1.3% to 2.1%). , with a subdivision hazard ratio of 1.12 per year (95% CI 1.06-1.18; P <0.001).

Limitations of these results include potential residual confusion, a lack of data on factors such as race and socio-economic health determinants, a potential immortal time bias, the ability to include people without atrial fibrillation, and a potential misjudgment of stroke risk.

Study researchers concluded that “elderly patients are more likely to benefit from anticoagulation therapy” and that “the estimate of stroke risk in patients with AF can be improved by models that use age as a continuous rather than a categorical variable to treat. ”

Disclosure: A study author stated links with biotech, pharmaceutical, and / or device companies. For a full list of the author’s disclosures, see the original reference.

reference

Abdel-Qadir H, Singh SM, Pang A, et al. Assessment of stroke risk without anticoagulation therapy in men and women with atrial fibrillation aged 66 to 74 years without other CHA2DS2-VASc factors. JAMA Cardiol. Published online May 19, 2021. doi: 10.1001 / jamacardio.2021.1232

This article originally appeared on The Cardiology Advisor

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