Staerk L, et al. - In this Danish nationwide registry-based study, including oral anticoagulant (OAC)-treated atrial fibrillation (AF) patients experiencing traumatic injury, the risks of all-cause mortality, stroke, major bleeding, and recurrent traumatic injury were assessed in association with resumption of vitamin K antagonists (VKAs) and non-VKAs oral anticoagulants (NOACs) following traumatic injury. Post-injury resumption of VKA and NOAC treatment resulted in lower hazard of all-cause mortality and ischaemic stroke, increased hazard of major bleeding but without additional hazards of recurrent traumatic injury. As per observations, withholding OAC following a traumatic injury in AF patients may not be warranted.

Methods

• This Danish nationwide registry-based study (2005–16) was performed on a total of 4541 oral anticoagulant (OAC)-treated AF patients experiencing traumatic injury (defined as traumatic brain injury, hip fracture, or traumatic torso or abdominal injury).

Results

• Data demonstrated that within 90 days following discharge from traumatic injury, 60.6% resumed VKA (median age = 80, CHA₂DS₂-VASc = 4, HAS-BLED = 2), 16.7% resumed NOAC (median age = 81, CHA₂DS₂-VASc = 4, HAS-BLED = 2), and 22.7% did not resume OAC treatment (median age = 81, CHA₂DS₂-VASc = 4, HAS-BLED = 3).
• Among 9.5%, switch from VKA to NOAC was reported.
• Since 2009, an increase was documented in the trend in OAC resumption (P-value <0.0001), in particular with NOACs (P-value <0.0001).
• According to data, follow-up started 90 days after discharge, and comparisons were performed using time-varying multiple Cox regression analyses.
• Researchers found that VKA and NOAC resumption vs non-resumption were related to lower hazard [95% confidence interval (CI)] of all-cause mortality [hazard ratio (HR) 0.48 (0.42–0.53) and HR 0.55 (0.47–0.66), respectively] and ischaemic stroke [HR 0.56 (0.43–0.72) and HR 0.54 (0.35–0.82), respectively], increased major bleeding hazard [HR 1.30 (1.03–1.64) and HR 1.15 (0.81–1.63), respectively], and similar hazard of recurrent traumatic injury [HR 0.93 (0.73–1.18) and HR 0.87 (0.60–1.27), respectively].