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Thromb Haemost 2016; 115(05): 1056-1063
DOI: 10.1160/TH16-01-0007
Stroke, Systemic or Venous Thromboembolism
Schattauer GmbH

Oral anticoagulation, stroke and thromboembolism in patients with atrial fibrillation and valve bioprosthesis

The Loire Valley Atrial Fibrillation Project
Raphael Philippart
1   Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université Franҫois Rabelais, Tours, France
,
Anne Brunet-Bernard
1   Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université Franҫois Rabelais, Tours, France
,
Nicolas Clementy
1   Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université Franҫois Rabelais, Tours, France
,
Thierry Bourguignon
1   Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université Franҫois Rabelais, Tours, France
,
Alain Mirza
1   Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université Franҫois Rabelais, Tours, France
,
Denis Angoulvant
1   Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université Franҫois Rabelais, Tours, France
,
Dominique Babuty
1   Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université Franҫois Rabelais, Tours, France
,
Gregory Y. H. Lip   *
2   University of Birmingham Institute for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom
,
Laurent Fauchier   *
1   Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université Franҫois Rabelais, Tours, France
› Author Affiliations Financial Support: This work was supported by a grant from the Société Française de Cardiologie.
Further Information

Publication History

Received: 06 January 2016

Accepted after major revision: 11 January 2016

Publication Date:
06 December 2017 (online)

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Summary

Vitamin K antagonists are currently recommended in patients with ‘valvular’ atrial fibrillation (AF), e. g. those having mitral stenosis or artificial heart valves. We compared thromboembolic risk in patients with ‘non valvular’ AF and in those with AF and biological valve replacement (valve bioprosthesis). Among 8962 AF patients seen between 2000 and 2010, a diagnosis of ‘non-valvular AF’ was found in 8053 (94 %). Among patients with ‘valvular’ AF, 549 (6 %) had a biological prosthesis. The patients with bioprosthesis were older and had a higher CHA2DS2-VASc score than those with non valvular AF. After a follow-up of 876 é 1048 days (median 400 days, interquartile range 12–1483), the occurrence of thromboembolic events was similar in AF patients with bioprosthesis compared to those with ‘non valvular’ AF (hazard ratio [HR] 1.10 95 % confidence interval [CI] 0.83–1.45, p=0.52, adjusted HR 0.93, 95 %CI 0.68–1.25, p=0.61). Factors independently associated with increased risk of stroke/TE events were older age (HR 1.25, 95 %CI 1.16–1.34 per 10-year increase, p> 0.0001) and higher CHA2DS2-VASc score (HR 1.35, 95 %CI 1.24–1.46, p> 0.0001) whilst female gender (HR 0.75, 95 %CI 0.62–0.90, p=0.002), use of vitamin K antagonist (HR 0.83, 95 %CI 0.71–0.98, p=0.03) were independently associated with a lower risk of stroke/TE. Neither the presence of bioprosthesis nor the location of bioprosthesis was independent predictor for TE events. In conclusion, AF patients with bioprosthesis had a non-significantly higher risk of stroke/TE events compared to patients with non-valvular AF. Second, the CHA2DS2-VASc score was independently associated with an increased risk of TE events, and was a valuable determinant of TE risk both in AF patients with non-valvular AF as well as those with bioprosthesis, whether treated or not treated with OAC.

Note: The review process for this paper was fully handled by Christian Weber, Editor in Chief.

Keywords

Atrial fibrillation - ischaemic stroke - biological valve prosthesis

* Joint senior authors.


 

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