Use of Oral Anticoagulants for Stroke Prevention in Patients with Atrial Fibrillation Who Have a History of Intracranial Hemorrhage

Tze Fan Chao, Chia Jen Liu, Jo Nan Liao, Kang Ling Wang, Yenn Jiang Lin, Shih Lin Chang, Li Wei Lo, Yu Feng Hu, Ta Chuan Tuan, Fa Po Chung, Tzeng Ji Chen, Gregory Y.H. Lip, Shih Ann Chen*

*此作品的通信作者

研究成果: Review article同行評審

100 引文 斯高帕斯(Scopus)

摘要

Background-The risk of further intracranial hemorrhage (ICH) and the benefit of stroke risk reduction with the use of oral anticoagulants for patients who have atrial fibrillation with a history of ICH remain unclear. We aimed to investigate the risks and benefits in patients who have atrial fibrillation with a previous ICH treated with warfarin or antiplatelet drugs in comparison with no antithrombotic therapies. Methods and Results-This study used the National Health Insurance Research Database in Taiwan. Among 307 640 patients who have atrial fibrillation with a CHA2DS2-VASc score ≧2, 12 917 patients with a history of ICH were identified and were assigned to 1 of 3 groups, that is, no treatment, antiplatelet therapy, and warfarin. Among patients with previous ICH, the rate of ICH and ischemic stroke in untreated patients was 4.2 and 5.8 per 100 person-years, respectively. The annual ICH and ischemic stroke rates in warfarin users were 5.9% and 3.4%, respectively. Among users of antiplatelet agents, the rates were 5.3% per year and 5.2% per year, respectively. The number needed to treat for preventing 1 ischemic stroke was lower than the number needed to harm for producing 1 ICH with warfarin use for patients with a CHA2DS2-VASc score ≧6 (37 versus 56). The number needed to treat was higher than the number needed to harm for patients with a CHA2DS2-VASc score <6 (63 versus 53). Conclusions-Warfarin use may be beneficial for patients who have atrial fibrillation with a previous ICH having a CHA2DS2-VASc score ≧6. Whether the use of non-vitamin K antagonist oral anticoagulants could lower the threshold for treatment deserves further study.

原文English
頁(從 - 到)1540-1547
頁數8
期刊Circulation
133
發行號16
DOIs
出版狀態Published - 19 4月 2016

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