OP-244 Warfarin Use in Patients with Nonvalvular Atrial Fibrillation: Analysis From A A Nationwide Cohort-TRAF (Turkish Atrial Fibrillation Data Base)

Abstract

Objective: Atrial fibrillation (AF) is the most common arrhythmia and it is associated with a five-fold risk of stroke. Atrial fibrillation associated ischaemic strokes and embolisms are more disabling and fatal. We aimed to investigate the time to ischemic stroke/embolism after the diagnosis of AF in patients who never used warfarin. Methods: We analyzed the records of 402674 patients over the age 18 who had the diagnosis of non-valvular atrial fibrillation (AF) according to ICD-10 code I48 from a nation-wide claims and utilization management system which processes claims for all health insurance funds in Turkey since 2007. In this study we have used completely anonymized data. Time-to-event analysis were used to measure the time to ischemic stroke/embolism after being diagnosed with AF. Results: A total of 28187 AF patients (7 %) had ischemic stroke or emboli. Time to ischemic stroke and emboli was 61,25 0,05 months from the first diagnosis of AF. Stroke/emboli was observed earlier in the patients with CHA2DS2-VASc score >1⁄4 2; mean 60,72 0,06 months. Stroke/emboli was observed in patients with CHA2DS2-VASc score 0 and 1 in mean 65,39 0,11 months and mean 65,02 0,09 months respectively. Conclusions: Stroke/emboli was observed in a significant portion of AF patients in 5 years, and increased risk score decreased time to ischemic/embolic event. Stroke/emboli is one of the most important adverse events in AF patients and contributes to mortality and observed earlier in patients with higher risk scores. Therefore anticoagulation and strict control is needed. Figure 1. Warfarin Use according to CHA2DS2-VASc Score -OP-243 Results of Anticoagulation in Patients with CHADS2 Score of 0 and CHA2DS2VASC Score of 1; An Investigation Using the National Turkish Atrial Fibriallation (TRAF) Registry. B. Yavuz, N. Ata, E. Oto, K. Aytemir, S. Okutucu, B. Evranos, D.K. Ozturk, R. Koselerli, E. Ertugay, Y.G. Ilhan, A.J. Camm, A. Oto. Kecioren Teaching and Research Hospital; Social Security Institution; Hacettepe University Faculty of Medicine; MITS; St George’s Medical School, London. The American Journal of Cardiology MARCH 13e16, 2014 10 IN AND C Objective: Atrial fibrillation is associated with ischaemic strokes. Stroke risk is not homogenous and is identified by risk stratification schemes created by adding the risk factors.A new risk score, CHA2DS2VASC risk scheme was developed to decrease the intermediate risk group of CHADS2 risk scheme and to decrease the confusion about anticoagulation. But it has also created a new confusion on anticoagulation of very low risk group of patients. Therefore to detect the effect of anticoagulation in CHADS2 score of 0 and CHA2DS2VASC score of 1 patients we compared offwarfarin and onwarfarin patientswhoseCHADS2 score was 0 and CHA2DS2VASC score was 1. Methods: We analyzed the records of 402674 patients over the age 18 who had the diagnosis of non-valvular atrial fibrillation (AF) according to ICD-10 code I48 from a nation-wide claims and utilization management system which processes claims for all health insurance funds in Turkey since 2007. In this study we have used completely anonymized data. Results: Twenty one percent of on warfarin group and 16% of off warfarin group was hospitalized over 5 years follow up. Major hemorrhage was more frequently encountered in on warfarin group than off warfarin group (2,7% and 1,3 respectively). Stroke/TIA/Systemic Embolism/Death composite endpoint was higher in on warfarin group than off warfarin group, (7,8% and 4,6% respectively). Conclusions: This analysis showed that both hospitalization and major hemorrhages were higher in on warfarin group and warfarin did not decrease the joint endpoint of thromboembolism and death in this low risk group. Therefore this result directs us to question the intermediate risk categorization of CHA2DS2VADSc risk scheme.