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Differential presentations of arterial thromboembolic events between venous thromboembolism and atrial fibrillation patients
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  • 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
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Ming-Shyan Lin
Chang Gung Memorial Hospital Chiayi Branch
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Chien-Chia Wu
Chang Gung Memorial Hospital
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Yung-Lung Chen
Chang Gung Memorial Hospital Kaohsiung Branch
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Jung-Jung Chang
Chiayi Chang Gung Memorial Hospital
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Pao-Hsien Chu
Chang Gung Memorial Hospital
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Gregory Lip
University of Liverpool
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Mien-Cheng Chen
Chang Gung Memorial Hospital Kaohsiung Branch
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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.

Peer review status:UNDER REVIEW

10 Feb 2021Submitted to International Journal of Clinical Practice
10 Feb 2021Assigned to Editor
10 Feb 2021Submission Checks Completed
19 Feb 2021Reviewer(s) Assigned