Journal
EXPERT REVIEW OF CLINICAL PHARMACOLOGY
Volume 16, Issue 7, Pages 677-684Publisher
TAYLOR & FRANCIS LTD
DOI: 10.1080/17512433.2023.2223973
Keywords
Anticoagulants; discontinuation; persistence; outcomes; stroke; mortality; hospitalization; atrial fibrillation
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This review study found that discontinuation of oral anticoagulant therapy in patients with atrial fibrillation increased the risk of stroke and mortality, but did not significantly affect the risk of major bleeding.
IntroductionOral anticoagulants (OACs) should generally be continued lifelong in patients with atrial fibrillation (AF) to ensure optimal benefits, unless contraindications arise. However, discontinuation of OACs might occur for various reasons, potentially affecting clinical outcomes. In this review, we synthesized evidence on the clinical outcomes following OAC discontinuation in patients with AF.MethodsWe conducted a systematic review and meta-analysis using PubMed, Embase and Scopus. Cohort or case-control studies were included if data were available on clinical outcomes of OAC discontinuation, compared with continuation, in patients with AF. A random-effect meta-analyses were conducted for key outcomes of stroke, mortality, and major bleeding.ResultsEighteen observational studies having a total of 283,418 patients were included. Discontinuation significantly increased the risk of stroke (hazard ratio [HR] 1.88; 95% confidence interval [CI] 1.58-2.23), all-cause (HR 1.90; 95% CI 1.40-2.59) and cardiovascular (HR 1.83; 95% CI 1.06-3.18) mortality. The risk of major bleeding was not significantly different between the discontinued and continued groups (HR 1.04; 95% CI 0.72-1.52).ConclusionsDiscontinuation of OAC therapy was associated with an increased risk of stroke and mortality, with no difference in the risk of major bleeding. Acknowledging heterogeneity among the studies, the findings underline the need to ensure continuity of OAC therapy in patients with AF to prevent thrombotic complications and associated mortality.PROSPERO registration numberCRD42020186116
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