Highlights
- •RAFFINE is one of the largest cohorts of Japanese patients with atrial fibrillation.
- •Stroke and major bleeding occurred more often in the secondary prevention group.
- •Prior stroke/TIA was an independent predictor of stroke/systemic embolism.
Abstract
Objectives
Clinical outcome data of primary and secondary prevention in patients with nonvalvular
atrial fibrillation (NVAF) after the introduction of direct oral anticoagulant (DOAC)
therapy are limited.
Materials and Methods
A subgroup analysis of the RAFFINE registry, an observational, multicenter, prospective
registry of Japanese patients with AF, was performed. Incidence rates of stroke or
systemic embolism, all-cause death, major bleeding, and intracranial hemorrhage were
compared between patients with and without a history of stroke or transient ischemic
attack (TIA).
Results
Of 3,706 NVAF patients at baseline, 557 (15.0%) had a history of ischemic stroke or
TIA (secondary prevention group), and 3,149 (85.0%) had no history of ischemic stroke
or TIA (primary prevention group). The proportion of patients receiving oral anticoagulants
was 87.2% (42.5% warfarin, 44.7% DOACs). The secondary prevention group had higher
rates of stroke or systemic embolism (2.6% vs 1.0%/year, p<0.001), all-cause death
(3.6% vs 2.4%/year, p<0.01), and major bleeding (2.0% vs 1.3%/year, p<0.01), and similar
rates of intracranial hemorrhage (0.6% vs 0.5%/year, p=0.66) compared with the primary
prevention group. A Cox proportional hazards model showed that a history of ischemic
stroke or TIA was independently associated with an increased risk of stroke or systemic
embolism (adjusted hazard ratio, 2.22; 95% confidence interval, 1.57 – 3.15; p<0.001).
Conclusions
In a contemporary cohort of NVAF patients, a history of ischemic stroke or TIA was
still an independent predictor of stroke or systemic embolism, despite advances in
anticoagulation therapy.
Keywords
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Article info
Publication history
Published online: November 07, 2022
Accepted:
October 31,
2022
Received in revised form:
October 19,
2022
Received:
August 13,
2022
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106871
Copyright
© 2022 Elsevier Inc. All rights reserved.
