loading page

Differential presentations of arterial thromboembolic events between venous thromboembolism and atrial fibrillation patients
  • +5
  • Yu-Sheng Lin,
  • Ming-Shyan Lin,
  • Chien-Chia Wu,
  • Yung-Lung Chen,
  • Jung-Jung Chang,
  • Pao-Hsien Chu,
  • Gregory Lip,
  • Mien-Cheng Chen
Yu-Sheng Lin
Chiayi Chang Gung Memorial Hospital

Corresponding Author:dissertlin@gmail.com

Author Profile
Ming-Shyan Lin
Chang Gung Memorial Hospital Chiayi Branch
Author Profile
Chien-Chia Wu
Chang Gung Memorial Hospital
Author Profile
Yung-Lung Chen
Chang Gung Memorial Hospital Kaohsiung Branch
Author Profile
Jung-Jung Chang
Chiayi Chang Gung Memorial Hospital
Author Profile
Pao-Hsien Chu
Chang Gung Memorial Hospital
Author Profile
Gregory Lip
University of Liverpool
Author Profile
Mien-Cheng Chen
Chang Gung Memorial Hospital Kaohsiung Branch
Author Profile

Abstract

Background: Atrial fibrillation (AF) and venous thromboembolism (VTE) share several risk factors related to arterial thromboembolism. No study has reported the differential contribution to arterial thromboembolic events and mortality between these two conditions in the same population. Methods: We included AF and VTE national cohorts derived from Taiwan National Health Insurance Research Database between 2001 and 2013. The eligible population was 314,861 patients in the AF cohort and 41,102 patients in the VTE cohort. The primary outcome was arterial thromboembolic events, including ischemic stroke, extracranial arterial thromboembolism (ECATE) and myocardial infarction (MI). Secondary outcomes were all-cause mortality and cardiovascular death. Results: After a 1:1 propensity matching, 32,688 patients in either group were analyzed. The risk of arterial thromboembolic events was lower in the VTE cohort than that in the AF cohort (subdistribution hazard ratio [SHR], 0.60; 95% confidence interval [CI], 0.57–0.62)). The risk of ischemic stroke (SHR, 0.44; 95% CI, 0.42–0.46) and MI (SHR, 0.80; 95% CI, 0.72–0.89) were lower in the VTE cohort, while the risk of ECATE (SHR, 1.23; 95% CI, 1.14–1.33; particularly lower extremities) was higher in the VTE cohort. All-cause mortality rate was higher in the VTE cohort (HR, 1.18; 95% CI, 1.15–1.21) while the risk of cardiovascular death was lower in the VTE cohort (HR, 0.96; 95% CI, 0.93–0.995). Conclusions: Patients with AF had higher risks of arterial thromboembolic events compared to patients with VTE, despite having risk factors in common. The VTE cohort had higher risks of all-cause mortality and ECATE, particularly lower extremity events, compared to AF patients. These differential manifestations of thromboembolism sequelae in AF and VTE merit further investigation.
06 Dec 2021Published in Frontiers in Cardiovascular Medicine volume 8. 10.3389/fcvm.2021.775564