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

Melgaard, Line, Jensen, Martin, Overvad, Thure Filskov, Larsen, Torben Bjerregaard, Lip, Gregory YH ORCID: 0000-0002-7566-1626 and Nielsen, Peter Brønnum (2020) Thromboembolic and bleeding outcomes in patients with atrial fibrillation and valvular heart disease: A descriptive nationwide cohort study. International Journal of Clinical Practice, 74 (10). e13589-.

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Abstract

AIMS:The risks of thromboembolism and bleeding in patients with atrial fibrillation (AF) and valvular heart disease (VHD) are sparsely described. We described the risk of events in non-anticoagulated and anticoagulated patients with AF and VHD according to the EHRA classification, EHRA Type 1 and Type 2 VHD, and within subgroups of EHRA Type 1 and Type 2 VHD. METHODS AND RESULTS:Cohort study of AF patients with coexisting VHD, identified in nationwide Danish registries from 2000-2018. Risk of thromboembolism and bleeding after 1 year of follow-up were calculated in each group. We identified 28,770 incident AF patients with VHD. Not surprisingly, we observed the highest risks of thromboembolism in the non-anticoagulated AF patients with EHRA Type 1 and Type 2 VHD (4.9% vs. 2.6% and 3.2% vs. 1.9%) and the highest risks of bleeding in the anticoagulated AF patients with EHRA Type 1 and Type 2 VHD (6.6% vs. 4.3% and 6.1% vs. 4.9%). However, within the subgroups of AF patients with EHRA Type 1 and Type 2 VHD, we observed a large proportion of non-anticoagulated patients (32.9-49.2%), despite a CHA2 DS2 -VASc score of 2≤ in the majority of these patients (81.9-95.6%). CONCLUSIONS:When using data reflecting contemporary clinical practice, we observed markedly different risks of thromboembolism and bleeding in EHRA Type 1 and Type 2 VHD. Additionally, we observed a potential underuse of oral anticoagulation within the subgroups of AF patients with EHRA Type 1 and Type 2 VHD, underlining need for further attention on this patient group.

Item Type:	Article
Uncontrolled Keywords:	Anticoagulation, Atrial fibrillation, Bleeding, Thromboembolism, Valvular heart disease
Depositing User:	Symplectic Admin
Date Deposited:	12 Aug 2020 10:36
Last Modified:	18 Jan 2023 23:37
DOI:	10.1111/ijcp.13589
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3097284