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Should We Reintroduce Previous Venous Thromboembolism Into Decision-Making for Anticoagulation in Atrial

Thure Filskov Overvad1, Flemming Skjøth2, Ida Ehlers Albertsen3

  • 1Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Denmark; Department of Medicine, North Denmark Regional Hospital, Hjørring, Denmark.

The American Journal of Medicine
|July 8, 2020
PubMed

Insights

History of venous thromboembolism (VTE) did not increase stroke risk in atrial fibrillation patients. However, a prior VTE history indicates a higher overall risk for future thromboembolic events, including VTE itself.

Area of Science:

  • Cardiology
  • Hematology
  • Epidemiology

Background:

  • Atrial fibrillation (AF) is a major risk factor for thromboembolic events.
  • The prognostic significance of a prior history of venous thromboembolism (VTE) in AF patients remains unclear.

Purpose of the Study:

  • To determine if a history of VTE impacts the risk of future thromboembolic events in patients diagnosed with atrial fibrillation.

Main Methods:

  • Nationwide cohort study (2000-2017) using Danish health registries.
  • Included 246,313 patients with incident atrial fibrillation.
  • Cox regression analyses adjusted for CHA₂DS₂-VASc score components and oral anticoagulation use.

Main Results:

  • Patients with prior VTE had a similar adjusted risk for ischemic stroke or systemic embolism (HR 0.99; 95% CI, 0.90-1.09).
  • Patients with prior VTE faced a significantly higher risk for a composite outcome including VTE (HR 1.76; 95% CI, 1.64-1.90).
  • Findings were consistent across VTE subtypes, low CHA₂DS₂-VASc scores, and non-anticoagulated patients.

Conclusions:

  • Prior VTE history does not elevate stroke risk in AF patients.
  • Individuals with AF and prior VTE represent a high-risk group due to increased risk of future VTE.
  • This risk stratification is crucial for oral anticoagulation decision-making in AF patients.
Abstract

Keywords:
AnticoagulationAtrial fibrillationRisk stratificationStrokeVenous thromboembolism

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