Residual Stroke Risk Among Patients With Atrial Fibrillation Prescribed Oral Anticoagulants: A Patient‐Level Meta‐Analysis From COMBINE AF

作者：Linda Johnson, Alexander P. Benz, Ashkan Shoamanesh, John W. Eikelboom, Michael D. Ezekowitz, Robert P. Giugliano, Lars Wallentin, Christian T. Ruff, Renato D. Lópes, Sanjit S. Jolly, Richard Whitlock, Christopher B. Granger, Stuart J. Connolly, Jeff S. Healey · 发表于：Journal of the American Heart Association · 年份：2024 · DOI：10.1161/jaha.123.034758 · 被引用次数：27 · 研究领域：Atrial Fibrillation Management and Outcomes、Venous Thromboembolism Diagnosis and Management、Antiplatelet Therapy and Cardiovascular Diseases

Background Despite oral anticoagulation, patients with atrial fibrillation (AF) remain at risk of ischemic stroke and systemic embolism (SE) events. For patients whose residual risk is sufficiently high, additional therapies might be useful to mitigate stroke risk. Methods and Results Individual patient data from 5 landmark trials testing oral anticoagulation in AF were pooled in A Collaboration Between Multiple Institutions to Better Investigate Non‐Vitamin K Antagonist Oral Anticoagulant Use in AF (COMBINE AF). We calculated the rate of ischemic stroke/SE among oral anticoagulation–treated patients with a CHA 2 DS 2 ‐VASc score≥2, across strata of CHA 2 DS 2 ‐VASc score, stroke history, and AF type, as either paroxysmal or nonparoxysmal. We included 71 794 patients with AF (median age 72 years, interquartile range, 13 years, 61.3% male) randomized to a direct oral anticoagulant or vitamin K antagonist, and followed for a mean of 2.1 (±0.8) years. The median CHA 2 DS 2 ‐VASc score was 4 (interquartile range, 3–5), 18.8% had a prior stroke, and 76.4% had nonparoxysmal AF. The overall rate of stroke/SE was 1.33%/y (95% CI, 1.27–1.39); 1.38%/y (95% CI, 1.31–1.45) for nonparoxysmal AF, and 1.15%/y (95% CI, 1.05–1.27) for paroxysmal AF. The rate of ischemic stroke/SE increased by a rate ratio of 1.36 (95% CI, 1.32–1.41) per 1‐point increase in CHA 2 DS 2 ‐VASc, reaching 1.67%/y (95% CI, 1.59–1.75) ≥4 CHA 2 DS 2 ‐VASc points. Patients with both nonparoxysmal AF and CHA 2 DS 2 ‐VAS...