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Oral Anticoagulation and Adverse Outcomes after Ischemic Stroke in Heart Failure Patients without Atrial Fibrillation.
- Source :
-
Journal of cardiac failure [J Card Fail] 2021 Aug; Vol. 27 (8), pp. 857-864. Date of Electronic Publication: 2021 May 04. - Publication Year :
- 2021
-
Abstract
- Background: The safety and effectiveness of oral anticoagulation (OAC) after an ischemic stroke in older patients with heart failure (HF) without atrial fibrillation remains uncertain.<br />Methods: Utilizing Get With The Guidelines Stroke national clinical registry data linked to Medicare claims from 2009-2014, we assessed the outcomes of eligible patients with a history of HF who were initiated on OAC during a hospitalization for an acute ischemic stroke. The cumulative incidences of adverse events were calculated using Kaplan-Meier curves and adjusted Cox proportional hazard ratios were compared between patients discharged on or off OAC.<br />Results: A total of 8,261 patients from 1,370 sites were discharged alive after an acute ischemic stroke and met eligibility criteria. Of those, 747 (9.0%) were initiated on OAC.  Patients on OAC were younger (77.2±8.0 vs. 80.5±8.9 years, p<0.01). After adjustment for clinical covariates, the likelihood of 1 year mortality was higher in those on OAC (aHR: 1.22, 95% CI 1.05-1.41, p<0.01), while no significant differences were noted for ICH (aHR: 1.34, 95% CI 0.69-2.59, p=0.38) and recurrent ischemic stroke (aHR: 0.78, 95% CI 0.54-1.15, p = 0.21).  The likelihood of all-cause bleeding (aHR: 1.59, 95% CI 1.29-1.96, p<0.01) and all-cause re-hospitalization (aHR: 1.14, 95% CI 1.02-1.27, p = 0.02) was higher for those on OAC.<br />Conclusion: Initiation of OAC after an ischemic stroke in older patients with HF in the absence of atrial fibrillation is associated with death, bleeding and re-hospitalization without an associated reduction in recurrent ischemic stroke. If validated, these findings raise caution for prescribing OAC to such patients.<br /> (Copyright © 2021 Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Anticoagulants adverse effects
Humans
Medicare
United States epidemiology
Atrial Fibrillation complications
Atrial Fibrillation drug therapy
Atrial Fibrillation epidemiology
Brain Ischemia diagnosis
Brain Ischemia epidemiology
Heart Failure complications
Heart Failure drug therapy
Heart Failure epidemiology
Ischemic Stroke
Stroke epidemiology
Stroke prevention & control
Subjects
Details
- Language :
- English
- ISSN :
- 1532-8414
- Volume :
- 27
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Journal of cardiac failure
- Publication Type :
- Academic Journal
- Accession number :
- 33975786
- Full Text :
- https://doi.org/10.1016/j.cardfail.2021.02.017