Antithrombotic Medication and the Risk of Vitreous Hemorrhage in Atrial Fibrillation: Korean National Health Insurance Service National Cohort
Yonsei Medical Journal
; : 65-72, 2019.
Article
in English
| WPRIM (Western Pacific)
| ID: wpr-719686
Responsible library:
WPRO
ABSTRACT
PURPOSE:
Antithrombotic therapy could be related with nuisance bleeding. This study investigated whether vitreous hemorrhage (VH) is associated with specific types of antithrombotic medication in patients with atrial fibrillation (AF). MATERIALS ANDMETHODS:
In the Korean National Health Insurance Service National Sample Cohort, we identified 9352 antiplatelet/anticoagulant-treated AF patients. The occurrence of VH was compared between warfarin (n=1493) and a propensity score (PS)-matched antiplatelet group (n=1493) and between warfarin (n=1493) and a PS-matched warfarin+antiplatelet group (n=1493).RESULTS:
The outcomes of VH were lower in the warfarin than in the matched antiplatelet (1.45 vs. 3.72 events/1000 patient-years) and matched warfarin+antiplatelet groups (1.45 vs. 6.87 events/1000 patient-years). Compared with warfarin, the risk of VH increased with antiplatelet [adjusted hazard ratio (aHR) 3.90; 95% confidence interval (CI) 1.22–12.4, p=0.022] and warfarin+antiplatelet agents (aHR 4.39, 95% CI 1.74–11.2, p=0.002). Compared with warfarin only, warfarin+antiplatelet agents increased the risk of VH in patients ≥65 years, regardless of gender and hypertension. The risk of VH was significantly higher with dual antiplatelet therapy (aHR 5.02, 95% CI 1.56–16.2, p=0.007) or in dual (aHR 5.02, 95% CI 1.74–14.5, p=0.003) or triple therapy using warfarin and antiplatelet agents than with warfarin monotherapy (aHR 6.12, 95% CI 1.76–21.3, p=0.004).CONCLUSION:
Dual antiplatelet or triple therapy increased the risk of VH significantly, compared to warfarin monotherapy. Considering the low efficacy of preventing ischemic stroke and high risk of bleeding, dual or triple therapy using warfarin and antiplatelet agents should be avoided to prevent VH in AF patients.
Full text:
Available
Database:
WPRIM (Western Pacific)
Main subject:
Atrial Fibrillation
/
Warfarin
/
Vitreous Hemorrhage
/
Platelet Aggregation Inhibitors
/
Cohort Studies
/
Stroke
/
Propensity Score
/
Hemorrhage
/
Hypertension
/
National Health Programs
Type of study:
Etiology study
/
Incidence study
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Observational study
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Prognostic study
/
Risk factors
Limits:
Humans
Language:
English
Journal:
Yonsei Medical Journal
Year:
2019
Document type:
Article