Differential presentations of arterial thromboembolic events between
venous thromboembolism and atrial fibrillation patients
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.