Warfarin treatment and risk of myocardial infarction - A cohort study of patients with atrial fibrillation treated in primary health care

INTERNATIONAL JOURNAL OF CARDIOLOGY

卷:221

Article

Wandell, Per^1,2  Carlsson, Axel C.^1,3  Holzmann, Martin J.^4,5  Arnlov, Johan^3,6  Johansson, Sven-Erik⁷  Sundquist, Jan⁷  Sundquist, Kristina⁷ 

[1] Karolinska Inst, Div Family Med, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden

[2] Stockholm Cty Council, Acad Primary Healthcare Ctr, Huddinge, Sweden

[3] Uppsala Univ, Dept Med Sci, Cardiovasc Epidemiol, Uppsala, Sweden

[4] Karolinska Univ Hosp, Dept Emergency Med, Stockholm, Sweden

[5] Karolinska Inst, Dept Internal Med, Stockholm, Sweden

[6] Dalarna Univ, Sch Hlth & Social Studies, Falun, Sweden

[7] Lund Univ, Ctr Primary Hlth Care Res, Malmo, Sweden

关键词: Atrial fibrillation;    Myocardial infarction;    Gender;    Follow-up;    Co-morbidity;    Anticoagulants;    Antiplatelets;   

DOI  :  10.1016/j.ijcard.2016.07.119

来源: Elsevier

【 摘 要 】

Objective: To study the risk of myocardial infarction (MI) in patients with atrial fibrillation (AF) treated in primary health care with warfarin or acetylsalicylic acid (ASA, aspirin). Methods: The study population included subjects (n = 12,283) 45 years or older diagnosed with AF who were treated in 75 primary care centres in Sweden between 2001 and 2007. MI was defined as a hospital stay for MI during 2001 through 2010 registered in the Swedish Patient Register. Associations between warfarin or ASA treatment and incident MI were explored using Cox regression analysis, by estimating hazard ratios (HRs) and 95% confidence intervals (95% CIs). Adjustment was made for age, socio-economic factors and cardio-vascular co-morbidity. Results: Persistent treatment (per protocol treatment) with warfarin alone was present among 32.4% of women and 37.4% of men, and with ASA alone among 30.0% of women and 28.1% of men. The fully adjusted HRs for MI, compared to those with no antithrombotic treatment, with warfarin treatment for women were 0.26 (95% CI 0.16-0.41) and for men 0.28 (95% CI 0.20-0.39); and the corresponding HRs for those treated with ASA were for women 0.57 (95% CI 0.37-0.87), and for men 0.44 95% CI (0.31-0.63). The fully adjusted HR for MI when comparing patients with warfarin treatment to those with ASA treatment was for women 0.46 (95% CI 0.27-0.80), and for men 0.58 (95% CI 0.38-0.89). Conclusions: Warfarin seems to prevent MI among AF patients in a primary healthcare setting, which emphasizes the importance of persistent anticoagulant treatment in those patients. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

【 授权许可】

Free