Resumption of oral anticoagulation following traumatic injury and risk of stroke and bleeding in patients with atrial fibrillation: a nationwide cohort study

Danish cohort study (n=4541) reported that AF patients resuming oral anticoagulation following traumatic injury have lower hazard of all-cause mortality and ischaemic stroke, increased hazard of major bleeding but without additional hazards of recurrent traumatic injury.

Compared with non-resumption, vitamin K antagonists (VKAs) and non-VKAs oral anticoagulants (NOACs) resumption were associated with:

 

• lower risk of all-cause mortality [(HR) 0.48 (0.42–0.53) and HR 0.55 (0.47–0.66), respectively]

• lower risk of ischaemic stroke [HR 0.56 (0.43–0.72) and HR 0.54 (0.35–0.82), respectively],

 

• increased risk of major bleeding hazard [HR 1.30 (1.03–1.64) and HR 1.15 (0.81–1.63), respectively],

• similar risk of recurrent traumatic injury [HR 0.93 (0.73–1.18) and HR 0.87 (0.60–1.27), respectively].

 

 

The researchers conclude that after traumatic injury, the complex decision of whether to resume oral anticoagulant (OAC) therapy, requires careful consideration of the balance between benefit (stroke prevention) and risk (bleeding) of OAC treatment. They suggest their results demonstrate that withholding of OAC is generally not beneficial to AF patients.