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Thromboembolic risk and effect of oral anticoagulation according to atrial fibrillation patterns: A systematic review

Alessio Lilli1, Andrea Di Cori2, Valerio Zacà3

  • 1Emergency Department, Cardiology, Versilia Hospital, Lido di Camaiore, Lucca, Italy.

Clinical Cardiology
|May 5, 2017
PubMed

Insights

Oral anticoagulation (OAC) is recommended for both paroxysmal and nonparoxysmal atrial fibrillation (AF). This meta-analysis confirms OAC reduces stroke and systemic embolism risk across all AF types, supporting its use regardless of AF pattern.

Area of Science:

  • Cardiology
  • Thrombosis Research
  • Clinical Epidemiology

Background:

  • Oral anticoagulation (OAC) is recommended for atrial fibrillation (AF), yet its use and impact in paroxysmal AF (pxAF) versus nonparoxysmal AF (non-pxAF) remain debated.
  • Conflicting data exist on stroke incidence in pxAF, leading to OAC underutilization in this patient group.

Purpose of the Study:

  • To compare the impact of OAC on stroke and systemic embolism (SE) outcomes in patients with pxAF and non-pxAF.
  • To evaluate the incidence rates of stroke/SE in different AF patterns, with and without OAC treatment.

Main Methods:

  • A systematic literature search identified prospective studies on stroke and SE risk in pxAF and non-pxAF, with or without OAC.
  • Quality of evidence was assessed using the GRADE approach.
  • Meta-regression analysis quantified the effect of OAC on stroke and SE incidence rates across 18 studies with 239,528 patient-years of follow-up.

Main Results:

  • The incidence rate of stroke/SE was 1.6% in pxAF and 2.3% in non-pxAF.
  • pxAF was associated with a significantly lower risk of overall thromboembolic (TE) events (risk ratio: 0.72) compared to non-pxAF.
  • OAC consistently reduced annual TE event rates in both pxAF (from 2.5% to 1.2%) and non-pxAF (from 3.7% to 1.7%), with no significant difference in major bleeding rates.

Conclusions:

  • While stroke/SE risk is lower in pxAF, it remains clinically meaningful.
  • OAC demonstrates consistent efficacy in reducing TE event rates irrespective of the AF pattern.
  • These findings provide robust evidence supporting the use of OAC in virtually all patients with AF, regardless of its specific pattern.

Keywords:
Oral AnticoagulantsParoxysmal Atrial FibrillationStrokeSystemic Embolism

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