Resumption of oral anticoagulation following traumatic injury and risk of stroke and bleeding in patients with atrial fibrillation: a nationwide cohort study
Authors' 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.
Study context
- Population
- Oral anticoagulant (OAC)-treated atrial fibrillation (AF) patients with traumatic injury (traumatic brain injury, hip fracture, or traumatic torso or abdominal injury), Denmark 2005–16
- Participants
- 4,541 patients
- Exposure
- VKA or NOAC resumption vs non-resumption of OAC after traumatic injury
- Outcome
- All-cause mortality, stroke, major bleeding and recurrent traumatic injury
- Follow-up
- From 90 days after discharge
Methodological detailsDanish nationwide registry, time-varying multiple Cox regression
- Danish nationwide registry
- Time-varying multiple Cox regression
Main finding
As reported in the abstract
Each group vs non-resumptionHazard ratio (95% CI)
VKAall-cause mortality
0.48(0.42–0.53)
NOACall-cause mortality
0.55(0.47–0.66)
VKAischaemic stroke
0.56(0.43–0.72)
NOACischaemic stroke
0.54(0.35–0.82)
VKArecurrent traumatic injury
0.93(0.73–1.18)
NOACrecurrent traumatic injury
0.87(0.60–1.27)
Observational data: associations, not effects.
Further findings
Trend in OAC resumption since 2009
- OAC resumption increased, in particular with NOACs
- P < 0.0001
Switch from VKA to NOAC
- Switch from VKA to NOAC
- 9.5%
Safety
| Outcome | HR (95% CI) | |
|---|---|---|
| Major bleedingVKA vs Non-resumption | 1.30 (1.03–1.64) | |
| Major bleedingNOAC vs Non-resumption | 1.15 (0.81–1.63) | |
| 0.512Hazard ratio (log scale) |
Original publication
Resumption of oral anticoagulation following traumatic injury and risk of stroke and bleeding in patients with atrial fibrillation: a nationwide cohort study. Eur Heart J. Published 18 November 2017. doi:10.
Summarised from the published abstract; every number is checked against it