Risk of arterial and venous thromboembolism in patients with atrial fibrillation or flutter: A nationwide population-based cohort study

Jens Sundbøll, E. Puhó, Kasper Adelborg, Anne Ording, Morten Schmidt, Hans Erik Bøtker, Henrik Toft Sørensen

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background Patients with atrial fibrillation or flutter (AFF) are at increased risk of ischemic stroke, but their risk of other thromboembolic events remains less clear. Methods During 2004–2013, we conducted a nationwide population-based cohort study using Danish medical registries. We identified all patients with first-time AFF and sampled a sex-, age-, and calendar year-matched general population comparison cohort without AFF. For myocardial infarction, peripheral embolism, ischemic stroke, hemorrhagic stroke, deep venous thrombosis, and pulmonary embolism, we computed cumulative risks and adjusted incidence rate ratios (aIRRs) adjusted for comorbidity and medication. Results The study population consisted of 103,989 patients with AFF and 519,935 individuals without AFF from the general population. Ten-year cumulative risks in the AFF cohort were 3.5% for myocardial infarction, 0.5% for peripheral embolism, 6.7% for ischemic stroke, 1.3% for hemorrhagic stroke, 1.0% for deep venous thrombosis, and 1.3% for pulmonary embolism. During the first 30 days following AFF, aIRRs were markedly (4 to 16-fold) increased for all outcomes and similarly elevated for myocardial infarction (aIRR = 8.0, 95% confidence interval (CI): 6.8–9.5) and ischemic stroke (aIRR = 9.9, 95% CI: 8.5–11.5). Thereafter, aIRRs decreased gradually, reaching unity after 5 years for myocardial infarction, deep venous thrombosis, and pulmonary embolism, but remained 1.6 to 3.5-fold increased for peripheral embolism, ischemic stroke, and hemorrhagic stroke. Conclusions AFF was a risk factor for all arterial and venous outcomes during the first year of follow-up, but only for peripheral embolism, ischemic stroke, and hemorrhagic stroke thereafter.

Original languageEnglish
Pages (from-to)182-187
Number of pages6
JournalInternational Journal of Cardiology
Volume241
DOIs
Publication statusPublished - Aug 15 2017

Fingerprint

Atrial Flutter
Venous Thromboembolism
Atrial Fibrillation
Cohort Studies
Stroke
Population
Embolism
Pulmonary Embolism
Myocardial Infarction
Venous Thrombosis
Incidence
Confidence Intervals
Registries
Comorbidity

Keywords

  • Arterial thrombosis
  • Atrial fibrillation
  • Epidemiology
  • Venous thrombosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Risk of arterial and venous thromboembolism in patients with atrial fibrillation or flutter : A nationwide population-based cohort study. / Sundbøll, Jens; Puhó, E.; Adelborg, Kasper; Ording, Anne; Schmidt, Morten; Bøtker, Hans Erik; Sørensen, Henrik Toft.

In: International Journal of Cardiology, Vol. 241, 15.08.2017, p. 182-187.

Research output: Contribution to journalArticle

Sundbøll, Jens ; Puhó, E. ; Adelborg, Kasper ; Ording, Anne ; Schmidt, Morten ; Bøtker, Hans Erik ; Sørensen, Henrik Toft. / Risk of arterial and venous thromboembolism in patients with atrial fibrillation or flutter : A nationwide population-based cohort study. In: International Journal of Cardiology. 2017 ; Vol. 241. pp. 182-187.
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abstract = "Background Patients with atrial fibrillation or flutter (AFF) are at increased risk of ischemic stroke, but their risk of other thromboembolic events remains less clear. Methods During 2004–2013, we conducted a nationwide population-based cohort study using Danish medical registries. We identified all patients with first-time AFF and sampled a sex-, age-, and calendar year-matched general population comparison cohort without AFF. For myocardial infarction, peripheral embolism, ischemic stroke, hemorrhagic stroke, deep venous thrombosis, and pulmonary embolism, we computed cumulative risks and adjusted incidence rate ratios (aIRRs) adjusted for comorbidity and medication. Results The study population consisted of 103,989 patients with AFF and 519,935 individuals without AFF from the general population. Ten-year cumulative risks in the AFF cohort were 3.5{\%} for myocardial infarction, 0.5{\%} for peripheral embolism, 6.7{\%} for ischemic stroke, 1.3{\%} for hemorrhagic stroke, 1.0{\%} for deep venous thrombosis, and 1.3{\%} for pulmonary embolism. During the first 30 days following AFF, aIRRs were markedly (4 to 16-fold) increased for all outcomes and similarly elevated for myocardial infarction (aIRR = 8.0, 95{\%} confidence interval (CI): 6.8–9.5) and ischemic stroke (aIRR = 9.9, 95{\%} CI: 8.5–11.5). Thereafter, aIRRs decreased gradually, reaching unity after 5 years for myocardial infarction, deep venous thrombosis, and pulmonary embolism, but remained 1.6 to 3.5-fold increased for peripheral embolism, ischemic stroke, and hemorrhagic stroke. Conclusions AFF was a risk factor for all arterial and venous outcomes during the first year of follow-up, but only for peripheral embolism, ischemic stroke, and hemorrhagic stroke thereafter.",
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T1 - Risk of arterial and venous thromboembolism in patients with atrial fibrillation or flutter

T2 - A nationwide population-based cohort study

AU - Sundbøll, Jens

AU - Puhó, E.

AU - Adelborg, Kasper

AU - Ording, Anne

AU - Schmidt, Morten

AU - Bøtker, Hans Erik

AU - Sørensen, Henrik Toft

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N2 - Background Patients with atrial fibrillation or flutter (AFF) are at increased risk of ischemic stroke, but their risk of other thromboembolic events remains less clear. Methods During 2004–2013, we conducted a nationwide population-based cohort study using Danish medical registries. We identified all patients with first-time AFF and sampled a sex-, age-, and calendar year-matched general population comparison cohort without AFF. For myocardial infarction, peripheral embolism, ischemic stroke, hemorrhagic stroke, deep venous thrombosis, and pulmonary embolism, we computed cumulative risks and adjusted incidence rate ratios (aIRRs) adjusted for comorbidity and medication. Results The study population consisted of 103,989 patients with AFF and 519,935 individuals without AFF from the general population. Ten-year cumulative risks in the AFF cohort were 3.5% for myocardial infarction, 0.5% for peripheral embolism, 6.7% for ischemic stroke, 1.3% for hemorrhagic stroke, 1.0% for deep venous thrombosis, and 1.3% for pulmonary embolism. During the first 30 days following AFF, aIRRs were markedly (4 to 16-fold) increased for all outcomes and similarly elevated for myocardial infarction (aIRR = 8.0, 95% confidence interval (CI): 6.8–9.5) and ischemic stroke (aIRR = 9.9, 95% CI: 8.5–11.5). Thereafter, aIRRs decreased gradually, reaching unity after 5 years for myocardial infarction, deep venous thrombosis, and pulmonary embolism, but remained 1.6 to 3.5-fold increased for peripheral embolism, ischemic stroke, and hemorrhagic stroke. Conclusions AFF was a risk factor for all arterial and venous outcomes during the first year of follow-up, but only for peripheral embolism, ischemic stroke, and hemorrhagic stroke thereafter.

AB - Background Patients with atrial fibrillation or flutter (AFF) are at increased risk of ischemic stroke, but their risk of other thromboembolic events remains less clear. Methods During 2004–2013, we conducted a nationwide population-based cohort study using Danish medical registries. We identified all patients with first-time AFF and sampled a sex-, age-, and calendar year-matched general population comparison cohort without AFF. For myocardial infarction, peripheral embolism, ischemic stroke, hemorrhagic stroke, deep venous thrombosis, and pulmonary embolism, we computed cumulative risks and adjusted incidence rate ratios (aIRRs) adjusted for comorbidity and medication. Results The study population consisted of 103,989 patients with AFF and 519,935 individuals without AFF from the general population. Ten-year cumulative risks in the AFF cohort were 3.5% for myocardial infarction, 0.5% for peripheral embolism, 6.7% for ischemic stroke, 1.3% for hemorrhagic stroke, 1.0% for deep venous thrombosis, and 1.3% for pulmonary embolism. During the first 30 days following AFF, aIRRs were markedly (4 to 16-fold) increased for all outcomes and similarly elevated for myocardial infarction (aIRR = 8.0, 95% confidence interval (CI): 6.8–9.5) and ischemic stroke (aIRR = 9.9, 95% CI: 8.5–11.5). Thereafter, aIRRs decreased gradually, reaching unity after 5 years for myocardial infarction, deep venous thrombosis, and pulmonary embolism, but remained 1.6 to 3.5-fold increased for peripheral embolism, ischemic stroke, and hemorrhagic stroke. Conclusions AFF was a risk factor for all arterial and venous outcomes during the first year of follow-up, but only for peripheral embolism, ischemic stroke, and hemorrhagic stroke thereafter.

KW - Arterial thrombosis

KW - Atrial fibrillation

KW - Epidemiology

KW - Venous thrombosis

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