All-cause mortality, stroke, and bleeding in patients with atrial fibrillation and valvular heart disease
- 17 February 2020
- journal article
- research article
- Published by Oxford University Press (OUP) in European Heart Journal - Cardiovascular Pharmacotherapy
- Vol. 7 (FI1), f93-f100
- https://doi.org/10.1093/ehjcvp/pvaa011
Abstract
Aims To compare the risk of all-cause mortality, stroke, and bleeding in patients with atrial fibrillation (AF) and valvular heart disease (VHD) treated with vitamin K antagonist (VKA) or factor Xa-inhibitors (FXa-I; rivaroxaban and apixaban). Methods and results We cross-linked data from Danish nationwide registries identifying patients with AF and VHD (aortic stenosis/insufficiency, mitral insufficiency, bioprosthetic heart valves, mitral-, and aortic valve repair) initiating VKA or FXa-I between January 2014 and June 2017. Outcomes were all-cause mortality, stroke, and bleeding. Using cause-specific Cox regression, we reported the standardized absolute 2-year risk of the outcomes and absolute risk differences (ARD). We identified 1115 (41.7%), 620 (23.1%), and 942 (35.2%) patients initiating treatment with VKA, rivaroxaban, and apixaban, respectively. The standardized absolute risk (95% confidence interval) of all-cause mortality associated with VKA treatment was 34.1% (30.4–37.8%) with corresponding ARD for FXa-I of −2.7% (−6.7% to 1.4%). The standardized absolute risk of stroke for VKA was 3.8% (2.2–5.4%) with corresponding ARD for FXa-I of –0.1% (−2.0% to 1.8%). The standardized risk of bleeding for VKA was 10.4% (7.2–12.9%) with corresponding ARD for FXa-I of –2.0% (−5.1% to 1.1%). The risk of bleeding was significantly reduced in subgroup analyses of apixaban compared with VKA [ARD: −3.9% (−7.0% to −0.9%)] and rivaroxaban [ARD: −5.6% (−9.5% to −1.7%)]. Conclusion In this nationwide cohort study, there were no significant differences in the risks of all-cause mortality, stroke, and bleeding in patients with AF and VHD treated with VKA compared with FXa-I.Keywords
Funding Information
- AstraZeneca
- Bayer
- Boehringer Ingelheim
- Bristol-Myers Squibb
- Pfizer
- MSD
- Mundipharma
- Portola Pharmaceuticals
- Roche
- Boehringer Ingelheim
- Bristol-Myers Squibb
- Boehringer Ingelheim
- Novartis Healthcare
- Novo Nordisk
- Foundation for Health Research
This publication has 30 references indexed in Scilit:
- Cardiovascular, Bleeding, and Mortality Risks in Elderly Medicare Patients Treated With Dabigatran or Warfarin for Nonvalvular Atrial FibrillationCirculation, 2015
- 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial FibrillationJournal of the American College of Cardiology, 2014
- What is ‘valvular’ atrial fibrillation? A reappraisalEuropean Heart Journal, 2014
- Clinical characteristics and outcomes with rivaroxaban vs. warfarin in patients with non-valvular atrial fibrillation but underlying native mitral and aortic valve disease participating in the ROCKET AF trialEuropean Heart Journal, 2014
- The Danish Civil Registration System as a tool in epidemiologyEuropean Journal of Epidemiology, 2014
- An automated database case definition for serious bleeding related to oral anticoagulant usePharmacoepidemiology and Drug Safety, 2011
- Validity of Stroke Diagnoses in a National Register of PatientsNeuroepidemiology, 2007
- Predictors of Cerebrovascular Events and Death Among Patients With Valvular Heart DiseaseStroke, 2000
- Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillationThe Annals of Thoracic Surgery, 1996