title: Stroke/thromboembolism and intracranial hemorrhage in a real-world atrial fibrillation population: the Complications of Atrial Fibrillation in the Bologna Area (CAFBO) study.
abstract: BACKGROUND
  Ischemic events (IEs) and intracranial hemorrhages (ICHs) are feared complications of atrial fibrillation (AF) and of antithrombotic treatment in patients with these conditions.
  
  
  METHODS
  Patients with AF admitted to the EDs of the Bologna, Italy, area with acute IE or ICH were prospectively recorded over 6 months.
  
  
  RESULTS
  A total of 178 patients (60 male patients; median age: 85 years) presented with acute IE. Antithrombotic therapy was as follows: (1) vitamin K antagonists (VKAs) in 31 patients (17.4%), with international normalized ratio (INR) at admission of < 2.0 in 16 patients, 2.0 to 3.0 in 13 patients, and > 3.0 in two patients; (2) aspirin (acetylsalicylic acid) (ASA) in 107 patients (60.1%); and (3) no treatment in 40 patients (22.5%), mainly because AF was not diagnosed. Twenty patients (eight male patients; median age: 82 years) presented with acute ICH: 13 (65%) received VKAs (INR, 2.0-3.0 in 11 patients and > 3.0 in two patients), while six (30%) received ASA. Most IEs (88%) and ICHs (95%) occurred in patients aged > 70 years. A modeling analysis of patients aged > 70 years was used to estimate annual incidence in subjects anticoagulated with VKAs in our Network of Anticoagulation Centers (NACs), or those expected to have AF but not included in NACs. The expected incidence of IE was 12.0%/y (95% CI, 10.7-13.3) in non-NACs and 0.57%/y (95% CI, 0.42-0.76) in NACs (absolute risk reduction [ARR], 11.4%/y; relative risk reduction [RRR], 95%; P < .0001). The incidence of ICH was 0.63%/y (95% CI, 0.34-1.04) and 0.30%/y (95% CI, 0.19-0.44), respectively (ARR, 0.33%/y; RRR, 52.4%/y; P = .04).
  
  
  CONCLUSIONS
  IEs occurred mainly in elderly patients who received ASA or no treatment. One-half of patients with IEs receiving anticoagulant treatment had subtherapeutic INRs. Therapeutic approaches to elderly subjects with AF require an effective anticoagulant treatment strategy.
authors.affiliation: Angiologia e Malattie della Coagulazione, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Sant'Orsola-Malpighi University Hospital, Bologna, Italy. Electronic address: gualtiero.palareti@unibo.it.
authors.forename: Gualtiero
authors.initials: G
authors.lastname: Palareti
authors.affiliation: Angiologia e Malattie della Coagulazione, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Salomone
authors.affiliation: Medicina D'Urgenza e Pronto Soccorso, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Cavazza
authors.affiliation: Medicina D'Urgenza e Pronto Soccorso, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Guidi
authors.affiliation: Stroke Unit, Medicina Interna, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Muscari
authors.affiliation: Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
authors.affiliation: Pronto Soccorso e Medicina D'Urgenza Ospedale Maggiore, Bologna, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Di Micoli
authors.affiliation: Pronto Soccorso e Medicina D'Urgenza Ospedale Maggiore, Bologna, Italy.
authors.forename: Giordano
authors.initials: G
authors.lastname: Guizzardi
authors.affiliation: IRCCS Institute of Neurological Sciences, Maggiore Hospital Stroke Unit, Bologna, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Procaccianti
authors.affiliation: Pronto Soccorso ed Emergenza Territoriale Area Nord, Bologna, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Guidetti
authors.affiliation: Pronto Soccorso ed Emergenza Territoriale Area Nord, Bologna, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Binetti
authors.affiliation: Stroke Care, Geriatria, Ospedale di Bentivoglio, Bologna, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Malservisi
authors.affiliation: Stroke Care, Geriatria, Ospedale di Bentivoglio, Bologna, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Masina
authors.affiliation: Pronto Soccorso ed Emergenza Territoriale Area Sud, Bologna, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Viola
authors.affiliation: Pronto Soccorso ed Emergenza Territoriale Area Sud, Bologna, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Bua
authors.affiliation: UOC Medicina Porretta-Vergato, Bologna, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Ongari
authors.affiliation: UOC Medicina Porretta-Vergato, Bologna, Italy.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Diaspri
authors.affiliation: University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, England.
authors.forename: Gregory Y H
authors.initials: GYH
authors.lastname: Lip
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications* / Q000188:drug therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D020300:Intracranial Hemorrhages / Q000188:drug therapy / Q000209:etiology*; D007558:Italy; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy / Q000209:etiology*; D013923:Thromboembolism / Q000188:drug therapy / Q000209:etiology*
chemical_list: D005343:Fibrinolytic Agents