Resumption of oral anticoagulation following traumatic injury and risk of stroke and bleeding in patients with atrial fibrillation: a nationwide cohort study

Laila Staerk; Emil Loldrup Fosbøl; Morten Lamberts; Anders Nissen Bonde; Kasper Gadsbøll; Caroline Sindet-Pedersen; Ellen A. Holm; Thomas Alexander Gerds; Brice Ozenne; Gregory Y H Lip; Christian Torp-Pedersen; Gunnar Hilmar Gislason; Jonas Bjerring Olesen

doi:10.1093/eurheartj/ehx598

Resumption of oral anticoagulation following traumatic injury and risk of stroke and bleeding in patients with atrial fibrillation: a nationwide cohort study

Laila Staerk, Emil Loldrup Fosbøl, Morten Lamberts, Anders Nissen Bonde, Kasper Gadsbøll, Caroline Sindet-Pedersen, Ellen A. Holm, Thomas Alexander Gerds, Brice Ozenne, Gregory Y H Lip, Christian Torp-Pedersen, Gunnar Hilmar Gislason, Jonas Bjerring Olesen

18 Citations (Scopus)

Abstract

Aims We examined the risks of all-cause mortality, stroke, major bleeding, and recurrent traumatic injury associated with resumption of vitamin K antagonists (VKAs) and non-VKAs oral anticoagulants (NOACs) following traumatic injury in atrial fibrillation (AF) patients. Methods and results This was a Danish nationwide registry-based study (2005-16), including 4541 oral anticoagulant (OAC)-treated AF patients experiencing traumatic injury (defined as traumatic brain injury, hip fracture, or traumatic torso or abdominal injury). Within 90 days following discharge from traumatic injury, 60.6% resumed VKA (median age = 80, CHA2DS2- VASc= 4, HAS-BLED= 2), 16.7% resumed NOAC (median age = 81, CHA2DS2-VASc= 4, HAS-BLED= 2), and 22.7% did not resume OAC treatment (median age = 81, CHA2DS2-VASc = 4, HAS-BLED= 3). Switch from VKA to NOAC occurred among 9.5%. Since 2009, the trend in OAC resumption increased (P-value <0.0001), in particular with NOACs (P-value <0.0001). Follow-up started 90 days after discharge, and time-varying multiple Cox regression analyses were used for comparisons. Compared with non-resumption, VKA and NOAC resumption were associated with lower hazard [95% confidence interval (CI)] of all-cause mortality [hazard ratio (HR) 0.48 (0.42-0.53) and HR 0.55 (0.47-0.66), respectively] and ischaemic stroke [HR 0.56 (0.43-0.72) and HR 0.54 (0.35-0.82), respectively], increased major bleeding hazard [HR 1.30 (1.03-1.64) and HR 1.15 (0.81-1.63), respectively], and similar hazard of recurrent traumatic injury [HR 0.93 (0.73-1.18) and HR 0.87 (0.60-1.27), respectively]. Conclusion AF patients resuming VKA and NOAC treatment following traumatic injury have lower hazard of all-cause mortality and ischaemic stroke, increased hazard of major bleeding but without additional hazards of recurrent traumatic injury. Withholding OAC following a traumatic injury in AF patients may not be warranted.

Original language	English
Journal	European Heart Journal
Volume	39
Issue number	19
Pages (from-to)	1698–1705
ISSN	0195-668X
DOIs	https://doi.org/10.1093/eurheartj/ehx598
Publication status	Published - 14 May 2018

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Staerk, L., Fosbøl, E. L., Lamberts, M., Bonde, A. N., Gadsbøll, K., Sindet-Pedersen, C., Holm, E. A., Gerds, T. A., Ozenne, B., Lip, G. Y. H., Torp-Pedersen, C., Gislason, G. H., & Olesen, J. B. (2018). Resumption of oral anticoagulation following traumatic injury and risk of stroke and bleeding in patients with atrial fibrillation: a nationwide cohort study. European Heart Journal, 39(19), 1698–1705. https://doi.org/10.1093/eurheartj/ehx598

Resumption of oral anticoagulation following traumatic injury and risk of stroke and bleeding in patients with atrial fibrillation: a nationwide cohort study. / Staerk, Laila; Fosbøl, Emil Loldrup; Lamberts, Morten et al.
In: European Heart Journal, Vol. 39, No. 19, 14.05.2018, p. 1698–1705.

Research output: Contribution to journal › Journal article › Research › peer-review

Staerk, L, Fosbøl, EL, Lamberts, M, Bonde, AN, Gadsbøll, K, Sindet-Pedersen, C, Holm, EA , Gerds, TA , Ozenne, B, Lip, GYH, Torp-Pedersen, C, Gislason, GH & Olesen, JB 2018, 'Resumption of oral anticoagulation following traumatic injury and risk of stroke and bleeding in patients with atrial fibrillation: a nationwide cohort study', European Heart Journal, vol. 39, no. 19, pp. 1698–1705. https://doi.org/10.1093/eurheartj/ehx598

@article{60343316acd844a1a1d6fa0e86816fc5,

title = "Resumption of oral anticoagulation following traumatic injury and risk of stroke and bleeding in patients with atrial fibrillation: a nationwide cohort study",

abstract = "Aims We examined the risks of all-cause mortality, stroke, major bleeding, and recurrent traumatic injury associated with resumption of vitamin K antagonists (VKAs) and non-VKAs oral anticoagulants (NOACs) following traumatic injury in atrial fibrillation (AF) patients. Methods and results This was a Danish nationwide registry-based study (2005-16), including 4541 oral anticoagulant (OAC)-treated AF patients experiencing traumatic injury (defined as traumatic brain injury, hip fracture, or traumatic torso or abdominal injury). Within 90 days following discharge from traumatic injury, 60.6% resumed VKA (median age = 80, CHA2DS2- VASc= 4, HAS-BLED= 2), 16.7% resumed NOAC (median age = 81, CHA2DS2-VASc= 4, HAS-BLED= 2), and 22.7% did not resume OAC treatment (median age = 81, CHA2DS2-VASc = 4, HAS-BLED= 3). Switch from VKA to NOAC occurred among 9.5%. Since 2009, the trend in OAC resumption increased (P-value <0.0001), in particular with NOACs (P-value <0.0001). Follow-up started 90 days after discharge, and time-varying multiple Cox regression analyses were used for comparisons. Compared with non-resumption, VKA and NOAC resumption were associated with lower hazard [95% confidence interval (CI)] of all-cause mortality [hazard ratio (HR) 0.48 (0.42-0.53) and HR 0.55 (0.47-0.66), respectively] and ischaemic stroke [HR 0.56 (0.43-0.72) and HR 0.54 (0.35-0.82), respectively], increased major bleeding hazard [HR 1.30 (1.03-1.64) and HR 1.15 (0.81-1.63), respectively], and similar hazard of recurrent traumatic injury [HR 0.93 (0.73-1.18) and HR 0.87 (0.60-1.27), respectively]. Conclusion AF patients resuming VKA and NOAC treatment following traumatic injury have lower hazard of all-cause mortality and ischaemic stroke, increased hazard of major bleeding but without additional hazards of recurrent traumatic injury. Withholding OAC following a traumatic injury in AF patients may not be warranted.",

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author = "Laila Staerk and Fosb{\o}l, {Emil Loldrup} and Morten Lamberts and Bonde, {Anders Nissen} and Kasper Gadsb{\o}ll and Caroline Sindet-Pedersen and Holm, {Ellen A.} and Gerds, {Thomas Alexander} and Brice Ozenne and Lip, {Gregory Y H} and Christian Torp-Pedersen and Gislason, {Gunnar Hilmar} and Olesen, {Jonas Bjerring}",

year = "2018",

month = may,

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doi = "10.1093/eurheartj/ehx598",

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TY - JOUR

T1 - Resumption of oral anticoagulation following traumatic injury and risk of stroke and bleeding in patients with atrial fibrillation

T2 - a nationwide cohort study

AU - Staerk, Laila

AU - Fosbøl, Emil Loldrup

AU - Lamberts, Morten

AU - Bonde, Anders Nissen

AU - Gadsbøll, Kasper

AU - Sindet-Pedersen, Caroline

AU - Holm, Ellen A.

AU - Gerds, Thomas Alexander

AU - Ozenne, Brice

AU - Lip, Gregory Y H

AU - Torp-Pedersen, Christian

AU - Gislason, Gunnar Hilmar

AU - Olesen, Jonas Bjerring

PY - 2018/5/14

Y1 - 2018/5/14

N2 - Aims We examined the risks of all-cause mortality, stroke, major bleeding, and recurrent traumatic injury associated with resumption of vitamin K antagonists (VKAs) and non-VKAs oral anticoagulants (NOACs) following traumatic injury in atrial fibrillation (AF) patients. Methods and results This was a Danish nationwide registry-based study (2005-16), including 4541 oral anticoagulant (OAC)-treated AF patients experiencing traumatic injury (defined as traumatic brain injury, hip fracture, or traumatic torso or abdominal injury). Within 90 days following discharge from traumatic injury, 60.6% resumed VKA (median age = 80, CHA2DS2- VASc= 4, HAS-BLED= 2), 16.7% resumed NOAC (median age = 81, CHA2DS2-VASc= 4, HAS-BLED= 2), and 22.7% did not resume OAC treatment (median age = 81, CHA2DS2-VASc = 4, HAS-BLED= 3). Switch from VKA to NOAC occurred among 9.5%. Since 2009, the trend in OAC resumption increased (P-value <0.0001), in particular with NOACs (P-value <0.0001). Follow-up started 90 days after discharge, and time-varying multiple Cox regression analyses were used for comparisons. Compared with non-resumption, VKA and NOAC resumption were associated with lower hazard [95% confidence interval (CI)] of all-cause mortality [hazard ratio (HR) 0.48 (0.42-0.53) and HR 0.55 (0.47-0.66), respectively] and ischaemic stroke [HR 0.56 (0.43-0.72) and HR 0.54 (0.35-0.82), respectively], increased major bleeding hazard [HR 1.30 (1.03-1.64) and HR 1.15 (0.81-1.63), respectively], and similar hazard of recurrent traumatic injury [HR 0.93 (0.73-1.18) and HR 0.87 (0.60-1.27), respectively]. Conclusion AF patients resuming VKA and NOAC treatment following traumatic injury have lower hazard of all-cause mortality and ischaemic stroke, increased hazard of major bleeding but without additional hazards of recurrent traumatic injury. Withholding OAC following a traumatic injury in AF patients may not be warranted.

AB - Aims We examined the risks of all-cause mortality, stroke, major bleeding, and recurrent traumatic injury associated with resumption of vitamin K antagonists (VKAs) and non-VKAs oral anticoagulants (NOACs) following traumatic injury in atrial fibrillation (AF) patients. Methods and results This was a Danish nationwide registry-based study (2005-16), including 4541 oral anticoagulant (OAC)-treated AF patients experiencing traumatic injury (defined as traumatic brain injury, hip fracture, or traumatic torso or abdominal injury). Within 90 days following discharge from traumatic injury, 60.6% resumed VKA (median age = 80, CHA2DS2- VASc= 4, HAS-BLED= 2), 16.7% resumed NOAC (median age = 81, CHA2DS2-VASc= 4, HAS-BLED= 2), and 22.7% did not resume OAC treatment (median age = 81, CHA2DS2-VASc = 4, HAS-BLED= 3). Switch from VKA to NOAC occurred among 9.5%. Since 2009, the trend in OAC resumption increased (P-value <0.0001), in particular with NOACs (P-value <0.0001). Follow-up started 90 days after discharge, and time-varying multiple Cox regression analyses were used for comparisons. Compared with non-resumption, VKA and NOAC resumption were associated with lower hazard [95% confidence interval (CI)] of all-cause mortality [hazard ratio (HR) 0.48 (0.42-0.53) and HR 0.55 (0.47-0.66), respectively] and ischaemic stroke [HR 0.56 (0.43-0.72) and HR 0.54 (0.35-0.82), respectively], increased major bleeding hazard [HR 1.30 (1.03-1.64) and HR 1.15 (0.81-1.63), respectively], and similar hazard of recurrent traumatic injury [HR 0.93 (0.73-1.18) and HR 0.87 (0.60-1.27), respectively]. Conclusion AF patients resuming VKA and NOAC treatment following traumatic injury have lower hazard of all-cause mortality and ischaemic stroke, increased hazard of major bleeding but without additional hazards of recurrent traumatic injury. Withholding OAC following a traumatic injury in AF patients may not be warranted.

KW - Journal Article

U2 - 10.1093/eurheartj/ehx598

DO - 10.1093/eurheartj/ehx598

M3 - Journal article

C2 - 29165556

SN - 0195-668X

VL - 39

SP - 1698

EP - 1705

JO - European Heart Journal

JF - European Heart Journal

IS - 19

ER -

Resumption of oral anticoagulation following traumatic injury and risk of stroke and bleeding in patients with atrial fibrillation: a nationwide cohort study

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