Hyperuricemia and the risk of ischemic stroke in patients with atrial fibrillation

Chao, Tze‐Fan; Liu, C.J.; Wang, K.L.; Chen, T.J.; Chen, S.A.

doi:10.1093/eurheartj/eht309.p4103

Cited by 1 publication

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“…27 Whether a diagnosis of concomitant OSA independently increases the risk of ischemic stroke in patients with NVAF remains unclear, with conflicting evidence being published. 8,10,11 Yaranov and colleagues assessed over 300 patients with AF as part of a chart review and identified a significant 3.65-fold increased risk of stroke in patients with OSA compared to those without. 8 The overall impact a diagnosis of OSA on outcomes in NVAF patients was assessed in an analysis of the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF).…”

Section: Discussionmentioning

confidence: 99%

“…7 In some, but not all studies, OSA has been shown to be an independent predictor of stroke in patients with AF. [8][9][10][11] Oral anticoagulation (OAC) with either a direct-acting oral anticoagulant (DOAC) or vitamin K antagonist (VKA) significantly decreases the risk of cardioembolic stroke in AF patients. 5 DOACs, including rivaroxaban, are recommended as first-line oral anticoagulants in the management nonvalvular AF (NVAF).…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness and Safety of Rivaroxaban Versus Warfarin among Nonvalvular Atrial Fibrillation Patients with Concomitant Obstructive Sleep Apnea

Sood

Ashton

Bessada

et al. 2023

TH Open

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Background: Obstructive sleep apnea (OSA) is associated with an increased incidence of atrial fibrillation (AF), hypertension, diabetes, heart failure, coronary heart disease, stroke, and death. We sought to evaluate the effectiveness and safety of rivaroxaban versus warfarin in nonvalvular AF (NVAF) patients with concomitant OSA. Methods: This was an analysis of electronic health record (EHR) data from 11/2010–12/2021. We included adults with NVAF and OSA at baseline, newly initiated on rivaroxaban or warfarin and with ≥12-months of prior EHR activity. Patients with valvular disease, alternative indications for oral anticoagulation, or who were pregnant were excluded. The incidence rates of developing stroke or systemic embolism (SSE) and bleeding-related hospitalization were evaluated. Hazard ratios (HR) and 95% confidence intervals (CIs) were calculated using propensity score-overlap weighted proportional hazards regression. Multiple sensitivity and subgroup analyses were performed. Results: We included 21,940 rivaroxaban (20.1% at the 15 mg dose) and 38,213 warfarin (time-in-therapeutic range=47.3±28.3%) patients. Rivaroxaban was found to have similar hazard of SSE compared to warfarin (HR=0.92, 95%CI=0.82–1.03). Rivaroxaban was associated with a reduced rate of bleeding-related hospitalizations (HR=0.85, 95%CI=0.78–0.92) versus warfarin, as well as reductions in intracranial (HR=0.76, 95%CI=0.62–0.94) and extracranial (HR=0.89, 95%CI=0.81–0.97) bleeding. Upon sensitivity analysis restricting the population to men with a CHA2DS2VASC score ≥2 or women with a score ≥3, rivaroxaban was associated with significant 33% risk reductions in SSE and 43% reduction in the risk of bleeding-related hospitalization. No significant interaction for the SSE or bleeding-related hospitalization outcomes were observed upon subgroup analyses. Conclusions: Among patients with NVAF and OSA, rivaroxaban had similar SSE risk versus warfarin but was associated with reductions in any, intracranial, and extracranial bleeding-related hospitalizations. Rivaroxaban was associated with significant reductions in SSE and bleeding-related hospitalizations when the study population was restricted to patients with a moderate-to-high risk of SSE. These data should provide prescribers with additional confidence in selecting rivaroxaban in NVAF patients who have OSA at time of anticoagulation initiation.

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