Author + information
- Received March 7, 2017
- Revision received July 31, 2017
- Accepted August 3, 2017
- Published online March 19, 2018.
- aDivision of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- bDivision of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
- cDivisions of General Internal Medicine and of Clinical Epidemiology, Department of Medicine, The Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- ↵∗Address for correspondence:
Dr. Louise Pilote, Division of Clinical Epidemiology, McGill University Health Centre, 1001 Decarie Boulevard, Room D05.5021, Montreal, Quebec H4A 3J1, Canada.
Objectives The purpose of this study was to determine if anticoagulation of patients with new onset secondary atrial fibrillation (AF) occurring with acute coronary syndromes (ACS), acute pulmonary disease, or sepsis is associated with a reduction in ischemic stroke or an increase in bleeding risk.
Background Studies evaluating the benefits and risks of anticoagulation in secondary AF are infrequent, and the optimal management of these patients is not well understood.
Methods A retrospective study cohort was identified of 2,304 patients age 65 years or older, hospitalized with a primary diagnosis of ACS, acute pulmonary disease (chronic obstructive pulmonary disease, pneumonia/influenza, pulmonary embolism, or pleural effusion) or sepsis, and a complication of new-onset AF during admission from 1999 to 2015.
Results Over a follow-up of ∼3 years, we did not identify any association between anticoagulation and a lower incidence of ischemic stroke in patients with new-onset AF occurring with ACS, acute pulmonary disease, or sepsis (odds ratio [OR]: 1.22 [95% confidence interval (CI): 0.65 to 2.27], OR: 0.97 [95% CI: 0.53 to 1.77], and OR: 1.98 [95% CI: 0.29 to 13.47]), after adjusting for confounders. However, anticoagulation was associated with a higher risk of bleeding in patients with AF associated with acute pulmonary disease (OR: 1.72 [95% CI: 1.23 to 2.39]), but not in ACS or sepsis (OR: 1.42 [95% CI: 0.94 to 2.14], OR: 0.96 [95% CI: 0.29 to 3.21]).
Conclusions Our study demonstrates that the benefit of anticoagulation in secondary AF is not strong and can be associated with a higher risk of bleeding. Careful individual assessment regarding decisions on anticoagulation is warranted in these patients.
This research was funded by a grant from the Canadian Institutes of Health Research. Dr. Pilote holds a James McGill chair at McGill University. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received March 7, 2017.
- Revision received July 31, 2017.
- Accepted August 3, 2017.
- 2018 American College of Cardiology Foundation