Geographical differences in thromboembolic and bleeding risks in patients with non-valvular atrial fibrillation : an ancillary analysis from the SPORTIF trials
Articolo
Data di Pubblicazione:
2017
Citazione:
Geographical differences in thromboembolic and bleeding risks in patients with non-valvular atrial fibrillation : an ancillary analysis from the SPORTIF trials / M. Proietti, G.Y. Lip. - In: INTERNATIONAL JOURNAL OF CARDIOLOGY. - ISSN 0167-5273. - 236(2017 Jun 01), pp. 244-248. [10.1016/j.ijcard.2017.02.127]
Abstract:
Background
Atrial fibrillation (AF) is associated with an increased risk of stroke, and the use of oral anticoagulation reduces stroke and all-cause mortality. Geographical differences may exist in AF risk factors, risk stratification and treatment strategies.
Methods
A post-hoc subgroup analysis derived from randomized controlled trials, the SPORTIF III and V trials, studying differences between European and North American warfarin-assigned non-valvular AF patients.
Results
Of 3359 patients 41.6% (n = 1397) were enrolled in Europe and 1962 (58.4%) from North America. CHA2DS2-VASc (p = 0.002) and HAS-BLED (p < 0.001) scores were higher in North Americans. Good anticoagulation control was more common in North American patients than Europeans.
1-Kaplan–Meier estimate curves show that North Americans had a lower risk of stroke/systemic embolic event (SEE) (p = 0.012), but higher risk of myocardial infarction(MI) (p = 0.007) and major bleeding (p < 0.001), compared to Europeans. Cox multivariate analysis confirmed a lower stroke/SEE risk (p = 0.008) and higher MI (p = 0.014) and major bleeding risks (p < 0.001) in North Americans.
Conclusions
Compared to European AF patients, North Americans had better anticoagulation control and higher thromboembolic and bleeding risk profiles. At follow-up, North American patients had lower stroke/SEE risk but higher MI and major bleeding risks compared to Europeans. Further studies are needed to understand these differences and the discordance between risk profile and lower stroke/SEE rates in North American compared to European patients.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
Atrial fibrillation; Bleeding risk; Geographical differences; Thromboembolic risk
Elenco autori:
M. Proietti, G.Y. Lip
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