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Comparative Study
. 2019 Feb 1;21(2):313-321.
doi: 10.1093/europace/euy181.

Clinical outcomes of solitary atrial flutter patients using anticoagulation therapy: a national cohort study

Yung-Lung Chen  1   2 , Yu-Sheng Lin  2   3 , Hui-Ting Wang  4 , Wen-Hao Liu  1 , Huang-Chung Chen  1 , Mien-Cheng Chen  1
Affiliations
Comparative Study

Clinical outcomes of solitary atrial flutter patients using anticoagulation therapy: a national cohort study

Yung-Lung Chen et al. Europace. .

Abstract

Aims: Anticoagulation therapy is indicated to prevent stroke in atrial flutter (AFL) and atrial fibrillation (AF) patients. However, the outcomes of solitary AFL patients may differ from those with AFL who develop AF during follow-up. This study aimed to investigate the differences in clinical outcomes: (i) among patients with solitary AFL, AF, and AFL developing AF thereafter and (ii) between solitary AFL patients with vs. without anticoagulation therapy.

Methods and results: This nationwide cohort study enrolled patients with solitary AFL, solitary AF, and AFL developing AF from a 12 years National Health Insurance Research Database in Taiwan. There were 230 367 patients without anticoagulation therapy in the solitary AF cohort, 8064 in the solitary AFL cohort, and 4495 in the AFL with AF cohort. The AFL with AF and solitary AF cohorts had higher incidences of ischaemic stroke and major bleeding than the solitary AFL cohort. Solitary AFL patients with anticoagulation therapy had a lower ischaemic stroke rate than those without (P < 0.05) at the level of a CHA2DS2-VASc score ≥3. Solitary AFL patients with anticoagulation therapy had a higher intracranial haemorrhage rate than those without (P < 0.05) at the level of a CHA2DS2-VASc score ≤3. Net clinical outcomes including ischaemic stroke, systemic embolization, and major bleeding favoured anticoagulation use in solitary AFL patients with a CHA2DS2-VASc score ≥4.

Conclusion: Solitary AFL patients without anticoagulation therapy had better clinical outcomes than AFL patients developing AF in this study. Anticoagulation therapy may offer the best net clinical outcome for solitary AFL patients with a CHA2DS2-VASc score ≥4.

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Figures

Figure 1
Figure 1
Flowchart of the study design. AF, atrial fibrillation; AFL, atrial flutter; OAC, oral anticoagulation.
Figure 2
Figure 2
Incidence density of (A) ischaemic stroke, (B) ischaemic stroke/systemic embolization, (C) intracranial haemorrhage, and (D) major bleeding, in each study group stratified by CHA2DS2-VASc score. AF, atrial fibrillation; AFL, atrial flutter; CI, confidence interval; HR, hazard ratio.
Figure 3
Figure 3
Impact of anticoagulation therapy status on the risk of (A) ischaemic stroke, (B) ischaemic stroke/systemic embolization, (C) intracranial haemorrhage, (D) major bleeding, and (E) composite events, which included major bleeding or ischaemic stroke/systemic embolization, in solitary AFL patients stratified by CHA2DS2-VASc score. Anticoagulation therapy has a good impact on solitary AFL participants with a CHA2DS2-VASc score in the slash area, but has a bad impact on those with a CHA2DS2-VASc score in the dot-area. AFL, atrial flutter; OAC, oral anticoagulation.
See this image and copyright information in PMC

Comment in

References

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