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Atrial fibrillation, liver disease, antithrombotics and risk of cerebrovascular events: A population-based cohort study
- Source :
- International journal of cardiology. 223
- Publication Year :
- 2016
-
Abstract
- Whether patients with atrial fibrillation (AF) and liver disease are also prone to cerebrovascular events and respond similarly favorably to antithrombotic therapy remains under-investigated.Patients ≥18years with newly-diagnosed AF in the period 2005 to 2009 were scrutinized from the "Longitudinal Health Insurance Database 2005" (1 million beneficiaries) of Taiwan's National Health Insurance Institute. Patients were categorized into the Liver (N=433) or the Non-liver (N=3490) cohort according to whether they had a diagnosis of advanced liver disease. Patients were then followed to determine cumulative incidence of hospitalization-requiring cerebrovascular events, preventive effects of antithrombotics, and predictors of cerebrovascular events by Cox regression analysis.Within a mean follow-up of 3.3±1.4years, ischemic stroke (89.2 vs. 50.3 per 1000 person-years, adjusted HR 1.502, 95% CI 1.207-1.868, p0.001) and overall cerebrovascular events (102.3 vs. 56.4 per 1000 person-years, adjusted HR 1.535, 95% CI 1.251-1.883, p0.001) occurred significantly more often in the Liver than in the Non-liver cohort. Cox models identified aging (≥65years), DM, and CHA2DS-VASc score≥2 points as risk factors for overall cerebrovascular events in the Liver cohort, whereas antiplatelet agents (HR 0.932, 95% CI 0.128-6.803, p=NS) and vit-K antagonistic anticoagulants (HR 1.087, 95% CI 0.150-7.862, p=NS) showed no correlation.AF patients comorbid with advanced liver disease are more vulnerable to ischemic and therein overall cerebrovascular events, especially in those with old age, DM, or high CHA2DS-VASc scores. This propensity to cerebrovascular events, however, can't be altered by antithrombotic therapy.
- Subjects :
- Male
medicine.medical_specialty
Taiwan
030204 cardiovascular system & hematology
Cohort Studies
03 medical and health sciences
Liver disease
Population based cohort
0302 clinical medicine
Fibrinolytic Agents
Risk Factors
Internal medicine
Antithrombotic
Atrial Fibrillation
medicine
Humans
Cumulative incidence
Longitudinal Studies
Stroke
Aged
Aged, 80 and over
Proportional hazards model
business.industry
Liver Diseases
Atrial fibrillation
Middle Aged
medicine.disease
Cerebrovascular Disorders
Population Surveillance
Cohort
Cardiology
030211 gastroenterology & hepatology
Female
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 18741754
- Volume :
- 223
- Database :
- OpenAIRE
- Journal :
- International journal of cardiology
- Accession number :
- edsair.doi.dedup.....711124e03d09c202a04946f1abc13b91