Stroke/thromboembolism and intracranial hemorrhage in a 'real world' atrial fibrillation population: The CAFBO STUDY (Complications of Atrial Fibrillation in the BOlogna area).

Chest

PubMedID: 24810397

Palareti G, Salomone L, Cavazza M, Guidi M, Muscari A, Boriani G, Di Micoli A, Guizzardi G, Procaccianti G, Guidetti A, Binetti N, Malservisi S, Masina M, Viola A, Bua V, Ongari M, Diaspri G, Lip GY. Stroke/thromboembolism and intracranial hemorrhage in a 'real world' atrial fibrillation population: The CAFBO STUDY (Complications of Atrial Fibrillation in the BOlogna area). Chest. 2014;146(4):1073-80.
ABSTRACT BACKGROUND Ischemic events (IEs) and intracranial hemorrhages (ICHs) are feared complications of atrial fibrillation (AF) and of antithrombotic treatment in such patients. METHODS AF patients admitted to the Emergency Units of the Bologna area (Italy) with acute IE or ICH were prospectively recorded over a 6 month period. RESULTS 178 patients (60 male; median age 85 y) presented with acute IE, antithrombotic therapy was: a) vitamin K antagonists (VKAs) in 31(17.4%), INR at admission: <2.0 in 16, 2.0-3.0 (ie.in range) 13, and > 3.0 in 2); b) aspirin (ASA) in 107 (60.1%); c) no treatment in 40 (22.5%), mainly because AF was not diagnosed. Twenty patients (8 male; median age 82 y) presented with acute ICH: 13 (65%) received VKAs (INR 2.0-3.0 in 11, >3.0 in 2); whilst 6 (30%) received ASA. Most IEs (88%) and ICH (95%) occurred in patients aged >70 y.A modeling analysis of patients aged >70 y was used to estimate annual incidence in subjects anticoagulated with VKAs in our Network of Anticoagulation Centers (NACs), or those expected to have AF but not included in NACs. The expected incidence of IE was 12.0%/year (95% CI 10.7-13.3) in non-NACs and 0.57 %/year (95% CI 0.42-0.76) in NACs (ARR: 11.4%/year ; RRR: 95%, p<0.0001). The incidence of ICH was 0.63%/year (95% CI 0.34-1.04) and 0.30%/year (95% CI 0.19-0.44), respectively (ARR: 0.33%/year; RRR: 52.4%/year, p= 0.04). CONCLUSION IEs occurred mainly in elderly patients who received ASA or no treatment. Half of anticoagulated patients with IEs had subtherapeutic INRs. Therapeutic approaches to elderly subjects with AF require an effective anticoagulant treatment strategy.