Stroke risk in anticoagulated patients with atrial fibrillation undergoing endoscopy.
OBJECTIVE
To determine the risk of stroke in anticoagulated patients with atrial fibrillation (AF) when anticoagulation is adjusted for bronchoscopy, gastroscopy, or colonoscopy, and to identify factors that could modify this risk.


METHODS
The authors reviewed patients with AF undergoing endoscopies between 1995 and 2001, with specific analysis of patients with AF in whom anticoagulation was adjusted for the procedures. The authors calculated the stroke rate within 30 days of the procedures.


RESULTS
Twelve strokes occurred in 987 patients undergoing 1,137 procedures (1.06%/procedure). The risk ranged from 0.31% for patients with nonvalvular AF undergoing routine procedures to 2.93% for complex patients undergoing endoscopies combined with other procedures or with comorbid illnesses. Patients with stroke were more likely to be complex (7/12 vs 219/975, p = 0.04); to be older than 80 years (6/12 vs 187/975, p = 0.017); to have a history of stroke (7/12 vs 194/975, p = 0.004), hypertension (10/12 vs 508/975, p = 0.04), or hyperlipidemia (9/12 vs 334/975, p = 0.005); or to have a family history of vascular disease (10/12 vs 502/975, p = 0.039).


CONCLUSIONS
The risk of stroke in patients with AF whose anticoagulation is adjusted for endoscopies is low, but almost tenfold higher in patients with complex clinical situations. Age, history of stroke, hypertension, hyperlipidemia, and family history of vascular disease may increase the risk of stroke.
Blacker
David J
DJ
Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.
Wijdicks
Eelco F M
EF
McClelland
Robyn L
RL
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications*; D001999:Bronchoscopy / Q000009:adverse effects*; D003113:Colonoscopy / Q000009:adverse effects*; D003710:Demography; D005260:Female; D005773:Gastroscopy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology* / Q000517:prevention & control
D000925:Anticoagulants