Antithrombotic Management and Long-Term Outcomes of Patients with Atrial Fibrillation. Insights from CRAFT Trial
Background: We aimed to compare long-term outcomes in Polish patients with atrial fibrillation (AF) according to oral anticoagulation (OAC) type and to evaluate the predictive value of common thromboembolic and bleeding risk scores. Methods: Data from the CRAFT trial (NCT02987062) were included. The...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-04-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/10/8/1780 |
| _version_ | 1797537132892389376 |
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| author | Paweł Balsam Piotr Lodziński Monika Gawałko Leszek Kraj Andrzej Śliwczyński Cezary Maciejewski Bartosz Krzowski Agata Tymińska Krzysztof Ozierański Marcin Grabowski Janusz Bednarski Grzegorz Opolski |
| author_facet | Paweł Balsam Piotr Lodziński Monika Gawałko Leszek Kraj Andrzej Śliwczyński Cezary Maciejewski Bartosz Krzowski Agata Tymińska Krzysztof Ozierański Marcin Grabowski Janusz Bednarski Grzegorz Opolski |
| author_sort | Paweł Balsam |
| collection | DOAJ |
| description | Background: We aimed to compare long-term outcomes in Polish patients with atrial fibrillation (AF) according to oral anticoagulation (OAC) type and to evaluate the predictive value of common thromboembolic and bleeding risk scores. Methods: Data from the CRAFT trial (NCT02987062) were included. The primary study endpoint was major adverse event (MAE; all-cause death, thromboembolic and hemorrhagic event) during the mean four-year follow-up period. Results: Out of 2983 patients with available follow-up data, 1686 (56%) were prescribed with vitamin K antagonist (VKA), 891 (30%) with rivaroxaban and 406 (14%) with dabigatran. Predominance of elderly and female patients with previous history of thromboembolic and hemorrhagic events was observed within rivaroxaban (vs. other OAC) group. Higher rate of MAEs and its components was observed in patients on VKA followed by rivaroxaban as compared to patients on dabigatran (43% vs. 42% vs. 31%, <i>p</i> < 0.01). After group matching based on clinical characteristics, higher risk of hemorrhagic events in VKA (vs. dabigatran) and rivaroxaban (vs. dabigatran) group were observed. The available thromboembolic (CHA<sub>2</sub>DS<sub>2</sub>-VASs, ATRIA, R<sub>2</sub>CHADS<sub>2</sub>) and bleeding (HAS-BLED, ATRIA, ORBIT) risk scores showed poor prediction value. Conclusions: Despite no difference in the thromboembolic event rate, treatment with VKA and rivaroxaban was associated with a significant increase in the risk of hemorrhagic events. |
| first_indexed | 2024-03-10T12:10:44Z |
| format | Article |
| id | doaj.art-8c9708fdaa3a441998d47574d6335041 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T12:10:44Z |
| publishDate | 2021-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-8c9708fdaa3a441998d47574d63350412023-11-21T16:14:18ZengMDPI AGJournal of Clinical Medicine2077-03832021-04-01108178010.3390/jcm10081780Antithrombotic Management and Long-Term Outcomes of Patients with Atrial Fibrillation. Insights from CRAFT TrialPaweł Balsam0Piotr Lodziński1Monika Gawałko2Leszek Kraj3Andrzej Śliwczyński4Cezary Maciejewski5Bartosz Krzowski6Agata Tymińska7Krzysztof Ozierański8Marcin Grabowski9Janusz Bednarski10Grzegorz Opolski111st Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland1st Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland1st Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, PolandDepartment of Oncology, Medical University of Warsaw, 02-091 Warsaw, PolandSatellite Campus in Warsaw, University of Humanities and Economics in Łódź, 90-212 Łódź, Poland1st Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland1st Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland1st Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland1st Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland1st Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, PolandCardiology Unit, St. John Paul II Western Hospital, 05-825 Grodzisk Mazowiecki, Poland1st Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, PolandBackground: We aimed to compare long-term outcomes in Polish patients with atrial fibrillation (AF) according to oral anticoagulation (OAC) type and to evaluate the predictive value of common thromboembolic and bleeding risk scores. Methods: Data from the CRAFT trial (NCT02987062) were included. The primary study endpoint was major adverse event (MAE; all-cause death, thromboembolic and hemorrhagic event) during the mean four-year follow-up period. Results: Out of 2983 patients with available follow-up data, 1686 (56%) were prescribed with vitamin K antagonist (VKA), 891 (30%) with rivaroxaban and 406 (14%) with dabigatran. Predominance of elderly and female patients with previous history of thromboembolic and hemorrhagic events was observed within rivaroxaban (vs. other OAC) group. Higher rate of MAEs and its components was observed in patients on VKA followed by rivaroxaban as compared to patients on dabigatran (43% vs. 42% vs. 31%, <i>p</i> < 0.01). After group matching based on clinical characteristics, higher risk of hemorrhagic events in VKA (vs. dabigatran) and rivaroxaban (vs. dabigatran) group were observed. The available thromboembolic (CHA<sub>2</sub>DS<sub>2</sub>-VASs, ATRIA, R<sub>2</sub>CHADS<sub>2</sub>) and bleeding (HAS-BLED, ATRIA, ORBIT) risk scores showed poor prediction value. Conclusions: Despite no difference in the thromboembolic event rate, treatment with VKA and rivaroxaban was associated with a significant increase in the risk of hemorrhagic events.https://www.mdpi.com/2077-0383/10/8/1780anticoagulationarrhythmiadabigatranrivaroxabanrisk scores |
| spellingShingle | Paweł Balsam Piotr Lodziński Monika Gawałko Leszek Kraj Andrzej Śliwczyński Cezary Maciejewski Bartosz Krzowski Agata Tymińska Krzysztof Ozierański Marcin Grabowski Janusz Bednarski Grzegorz Opolski Antithrombotic Management and Long-Term Outcomes of Patients with Atrial Fibrillation. Insights from CRAFT Trial Journal of Clinical Medicine anticoagulation arrhythmia dabigatran rivaroxaban risk scores |
| title | Antithrombotic Management and Long-Term Outcomes of Patients with Atrial Fibrillation. Insights from CRAFT Trial |
| title_full | Antithrombotic Management and Long-Term Outcomes of Patients with Atrial Fibrillation. Insights from CRAFT Trial |
| title_fullStr | Antithrombotic Management and Long-Term Outcomes of Patients with Atrial Fibrillation. Insights from CRAFT Trial |
| title_full_unstemmed | Antithrombotic Management and Long-Term Outcomes of Patients with Atrial Fibrillation. Insights from CRAFT Trial |
| title_short | Antithrombotic Management and Long-Term Outcomes of Patients with Atrial Fibrillation. Insights from CRAFT Trial |
| title_sort | antithrombotic management and long term outcomes of patients with atrial fibrillation insights from craft trial |
| topic | anticoagulation arrhythmia dabigatran rivaroxaban risk scores |
| url | https://www.mdpi.com/2077-0383/10/8/1780 |
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