Increased short-term risk of thrombo-embolism or death after interruption of warfarin treatment in patients with atrial fibrillation

Jakob Raunsø; Christian Selmer; Jonas Bjerring Olesen; Mette Gitz Charlot; Anne-Marie S Olsen; Ditte-Marie Bretler; Jørn Dalsgaard Nielsen; Helena Dominguez; Niels Gadsbøll; Lars Køber; Gunnar H Gislason; Christian Torp-Pedersen; Morten Lock Hansen

doi:10.1093/eurheartj/ehr454

Increased short-term risk of thrombo-embolism or death after interruption of warfarin treatment in patients with atrial fibrillation

Jakob Raunsø, Christian Selmer, Jonas Bjerring Olesen, Mette Gitz Charlot, Anne-Marie S Olsen, Ditte-Marie Bretler, Jørn Dalsgaard Nielsen, Helena Dominguez, Niels Gadsbøll, Lars Køber, Gunnar H Gislason, Christian Torp-Pedersen, Morten Lock Hansen

54 Citations (Scopus)

Abstract

AIMS: It is presently unknown whether patients with atrial fibrillation (AF) are at increased risk of thrombo-embolic adverse events after interruption of warfarin treatment. The purpose of this study was to assess the risk and timing of thrombo-embolism after warfarin treatment interruption.

METHODS AND RESULTS: A retrospective, nationwide cohort study of all patients in Denmark treated with warfarin after a first hospitalization with AF in the period 1997-2008. Incidence rate ratios (IRRs) of thrombo-embolic events and all-cause mortality were calculated using the Poisson regression analyses. In total, 48 989 AF patients receiving warfarin treatment were included. Of these, 35 396 patients had at least one episode of warfarin treatment interruption. In all, 8255 deaths or thrombo-embolic events occurred during treatment interruption showing an initial clustering of events with 2717, 835, 500, and 427 events occurring during 0-90, 91-180, 181-270, and 271-360 days after treatment interruption, respectively. Correspondingly, the crude incidence rates were 31.6, 17.7, 12.3, and 11.4 events per 100 patient-years. In a multivariable analysis, the first 90-day interval of treatment interruption was associated with a markedly higher risk of death or thrombo-embolism (IRR 2.5; 95% confidence interval 2.3-2.8) vs. the interval of 271-360 days.

CONCLUSION: In patients with AF, an interruption of warfarin treatment is associated with a significantly increased short-term risk of death or thrombo-embolic events within the first 90 days of treatment interruption.

Original language	English
Journal	European Heart Journal (Online)
Volume	33
Issue number	15
Pages (from-to)	1886-92
Number of pages	7
ISSN	1522-9645
DOIs	https://doi.org/10.1093/eurheartj/ehr454
Publication status	Published - Aug 2012

Keywords

Aged
Aged, 80 and over
Anticoagulants
Atrial Fibrillation
Cause of Death
Denmark
Female
Hospitalization
Humans
Male
Retrospective Studies
Risk Factors
Thromboembolism
Warfarin
Withholding Treatment

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Raunsø, J., Selmer, C., Olesen, J. B., Charlot, M. G., Olsen, A-M. S., Bretler, D-M., Nielsen, J. D., Dominguez, H., Gadsbøll, N., Køber, L., Gislason, G. H., Torp-Pedersen, C., & Hansen, M. L. (2012). Increased short-term risk of thrombo-embolism or death after interruption of warfarin treatment in patients with atrial fibrillation. European Heart Journal (Online), 33(15), 1886-92. https://doi.org/10.1093/eurheartj/ehr454

Raunsø, J, Selmer, C, Olesen, JB, Charlot, MG, Olsen, A-MS, Bretler, D-M, Nielsen, JD, Dominguez, H, Gadsbøll, N, Køber, L , Gislason, GH , Torp-Pedersen, C & Hansen, ML 2012, 'Increased short-term risk of thrombo-embolism or death after interruption of warfarin treatment in patients with atrial fibrillation', European Heart Journal (Online), vol. 33, no. 15, pp. 1886-92. https://doi.org/10.1093/eurheartj/ehr454

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title = "Increased short-term risk of thrombo-embolism or death after interruption of warfarin treatment in patients with atrial fibrillation",

abstract = "AIMS: It is presently unknown whether patients with atrial fibrillation (AF) are at increased risk of thrombo-embolic adverse events after interruption of warfarin treatment. The purpose of this study was to assess the risk and timing of thrombo-embolism after warfarin treatment interruption.METHODS AND RESULTS: A retrospective, nationwide cohort study of all patients in Denmark treated with warfarin after a first hospitalization with AF in the period 1997-2008. Incidence rate ratios (IRRs) of thrombo-embolic events and all-cause mortality were calculated using the Poisson regression analyses. In total, 48 989 AF patients receiving warfarin treatment were included. Of these, 35 396 patients had at least one episode of warfarin treatment interruption. In all, 8255 deaths or thrombo-embolic events occurred during treatment interruption showing an initial clustering of events with 2717, 835, 500, and 427 events occurring during 0-90, 91-180, 181-270, and 271-360 days after treatment interruption, respectively. Correspondingly, the crude incidence rates were 31.6, 17.7, 12.3, and 11.4 events per 100 patient-years. In a multivariable analysis, the first 90-day interval of treatment interruption was associated with a markedly higher risk of death or thrombo-embolism (IRR 2.5; 95% confidence interval 2.3-2.8) vs. the interval of 271-360 days.CONCLUSION: In patients with AF, an interruption of warfarin treatment is associated with a significantly increased short-term risk of death or thrombo-embolic events within the first 90 days of treatment interruption.",

keywords = "Aged, Aged, 80 and over, Anticoagulants, Atrial Fibrillation, Cause of Death, Denmark, Female, Hospitalization, Humans, Male, Retrospective Studies, Risk Factors, Thromboembolism, Warfarin, Withholding Treatment",

author = "Jakob Rauns{\o} and Christian Selmer and Olesen, {Jonas Bjerring} and Charlot, {Mette Gitz} and Olsen, {Anne-Marie S} and Ditte-Marie Bretler and Nielsen, {J{\o}rn Dalsgaard} and Helena Dominguez and Niels Gadsb{\o}ll and Lars K{\o}ber and Gislason, {Gunnar H} and Christian Torp-Pedersen and Hansen, {Morten Lock}",

year = "2012",

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doi = "10.1093/eurheartj/ehr454",

language = "English",

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T1 - Increased short-term risk of thrombo-embolism or death after interruption of warfarin treatment in patients with atrial fibrillation

AU - Raunsø, Jakob

AU - Selmer, Christian

AU - Olesen, Jonas Bjerring

AU - Charlot, Mette Gitz

AU - Olsen, Anne-Marie S

AU - Bretler, Ditte-Marie

AU - Nielsen, Jørn Dalsgaard

AU - Dominguez, Helena

AU - Gadsbøll, Niels

AU - Køber, Lars

AU - Gislason, Gunnar H

AU - Torp-Pedersen, Christian

AU - Hansen, Morten Lock

PY - 2012/8

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N2 - AIMS: It is presently unknown whether patients with atrial fibrillation (AF) are at increased risk of thrombo-embolic adverse events after interruption of warfarin treatment. The purpose of this study was to assess the risk and timing of thrombo-embolism after warfarin treatment interruption.METHODS AND RESULTS: A retrospective, nationwide cohort study of all patients in Denmark treated with warfarin after a first hospitalization with AF in the period 1997-2008. Incidence rate ratios (IRRs) of thrombo-embolic events and all-cause mortality were calculated using the Poisson regression analyses. In total, 48 989 AF patients receiving warfarin treatment were included. Of these, 35 396 patients had at least one episode of warfarin treatment interruption. In all, 8255 deaths or thrombo-embolic events occurred during treatment interruption showing an initial clustering of events with 2717, 835, 500, and 427 events occurring during 0-90, 91-180, 181-270, and 271-360 days after treatment interruption, respectively. Correspondingly, the crude incidence rates were 31.6, 17.7, 12.3, and 11.4 events per 100 patient-years. In a multivariable analysis, the first 90-day interval of treatment interruption was associated with a markedly higher risk of death or thrombo-embolism (IRR 2.5; 95% confidence interval 2.3-2.8) vs. the interval of 271-360 days.CONCLUSION: In patients with AF, an interruption of warfarin treatment is associated with a significantly increased short-term risk of death or thrombo-embolic events within the first 90 days of treatment interruption.

AB - AIMS: It is presently unknown whether patients with atrial fibrillation (AF) are at increased risk of thrombo-embolic adverse events after interruption of warfarin treatment. The purpose of this study was to assess the risk and timing of thrombo-embolism after warfarin treatment interruption.METHODS AND RESULTS: A retrospective, nationwide cohort study of all patients in Denmark treated with warfarin after a first hospitalization with AF in the period 1997-2008. Incidence rate ratios (IRRs) of thrombo-embolic events and all-cause mortality were calculated using the Poisson regression analyses. In total, 48 989 AF patients receiving warfarin treatment were included. Of these, 35 396 patients had at least one episode of warfarin treatment interruption. In all, 8255 deaths or thrombo-embolic events occurred during treatment interruption showing an initial clustering of events with 2717, 835, 500, and 427 events occurring during 0-90, 91-180, 181-270, and 271-360 days after treatment interruption, respectively. Correspondingly, the crude incidence rates were 31.6, 17.7, 12.3, and 11.4 events per 100 patient-years. In a multivariable analysis, the first 90-day interval of treatment interruption was associated with a markedly higher risk of death or thrombo-embolism (IRR 2.5; 95% confidence interval 2.3-2.8) vs. the interval of 271-360 days.CONCLUSION: In patients with AF, an interruption of warfarin treatment is associated with a significantly increased short-term risk of death or thrombo-embolic events within the first 90 days of treatment interruption.

KW - Aged

KW - Aged, 80 and over

KW - Anticoagulants

KW - Atrial Fibrillation

KW - Cause of Death

KW - Denmark

KW - Female

KW - Hospitalization

KW - Humans

KW - Male

KW - Retrospective Studies

KW - Risk Factors

KW - Thromboembolism

KW - Warfarin

KW - Withholding Treatment

U2 - 10.1093/eurheartj/ehr454

DO - 10.1093/eurheartj/ehr454

M3 - Journal article

C2 - 22199117

SN - 0195-668X

VL - 33

SP - 1886

EP - 1892

JO - European Heart Journal

JF - European Heart Journal

IS - 15

ER -

Increased short-term risk of thrombo-embolism or death after interruption of warfarin treatment in patients with atrial fibrillation

Abstract

Keywords

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