Abstract
Objective: Atrial fibrillation (AF) and venous thromboembolism (VTE) share several risk factors related to arterial thromboembolism. No study has reported the differential contribution to arterial thromboembolic events and mortality between these two conditions in the same population. We therefore assessed the differential arterial thromboembolic events between AF and VTE.Methods: We included AF and VTE national cohorts derived from Taiwan National Health Insurance Research Database between 2001 and 2013. The eligible population was 314,861 patients in the AF cohort and 41,102 patients in the VTE cohort. The primary outcome was arterial thromboembolic events, including ischemic stroke, extracranial arterial thromboembolism (ECATE) and myocardial infarction (MI). Secondary outcomes were all-cause mortality and cardiovascular death.Results: After a 1:1 propensity matching, 32,688 patients in either group were analyzed. The risk of arterial thromboembolic events was lower in the VTE cohort than that in the AF cohort (subdistribution hazard ratio [SHR], 0.60; 95% confidence interval [CI], 0.57–0.62). The risk of ischemic stroke (SHR, 0.44; 95% CI, 0.42–0.46) and MI (SHR, 0.80; 95% CI, 0.72–0.89) were lower in the VTE cohort, while the risk of ECATE (SHR, 1.23; 95% CI, 1.14–1.33; particularly lower extremities) was higher in the VTE cohort. All-cause mortality rate was higher in the VTE cohort (HR, 1.18; 95% CI, 1.15–1.21) while the risk of cardiovascular death was lower in the VTE cohort (HR, 0.96; 95% CI, 0.93–0.995).Conclusions: Patients with AF had higher risks of arterial thromboembolic events compared to patients with VTE, despite having risk factors in common. The VTE cohort had higher risks of all-cause mortality and ECATE, particularly lower extremity events, compared to AF patients. The differential manifestations of thromboembolism sequelae and mortality between AF and VTE patients merit further investigation.
Highlights
Atrial fibrillation (AF) is associated with an increased risk of stroke, systemic thromboembolic events, and mortality [1]
This study enrolled 314,861 AF patients and 41,102 venous thromboembolism (VTE) patients. These two cohorts were different in age distribution, whereby the VTE cohort was predominantly age < 65 years while the AF cohort was predominantly age ≥ 75 years (Table 1)
Anticoagulant use was continuous in the AF cohorts while the duration of anticoagulant was at least for 3∼6 months in the VTE cohort and 38.6% of VTE patients had the duration of anticoagulant use for more than 6 months
Summary
Atrial fibrillation (AF) is associated with an increased risk of stroke, systemic thromboembolic events, and mortality [1]. The pathogenesis of arterial thromboembolism in AF has been associated with a prothrombotic state by fulfilling Virchow’s triad for thrombogenesis, i.e., with abnormal blood flow (stasis) in the atria, vessel wall abnormalities and abnormal blood constituents (coagulation factors) as well as inflammation [4]. The pathogenesis of arterial thromboembolism in VTE has been associated with a prothrombotic state, i.e., with abnormal blood flow (stasis) in the vessels, vessel wall abnormalities and abnormal blood constituents (coagulation factors) as well as inflammation [5, 6]. Several studies showed that VTE increases risk of atherothrombotic cardiovascular events, including myocardial infarction (MI) [7]. Long-term anticoagulation should be prescribed for AF patients [2, 14] whereas more limited-duration of anticoagulation is sometimes prescribed for VTE patients unless there are high risk features for recurrence [3, 15]
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