title: Atrial fibrillation, CHA2DS2-VASc score, antithrombotics and risk of traffic accidents: A population-based cohort study.
abstract: BACKGROUND
  Traffic accidents account for a substantial proportion of premature disabilities and deaths. Whether atrial fibrillation (AF) provokes while antithrombotics prevent from such events remains un-investigated.
  
  
  METHODS
  All patients ≥40years with newly diagnosed AF in 2005 were scrutinized from the "Longitudinal Health Insurance Database 2005" (1 million beneficiaries) of Taiwan's National Health Insurance Institute as the AF group. Four-fold number of age-, gender-, and comorbidity-matched patients but without AF served as the Non-AF controls. Patients were followed till occurrence of hospitalization-requiring traffic injury, death, withdrawal from insurance, or the end of 2010. Cumulative incidence of traffic accidents was compared between groups, and predictors and preventive role of antithrombotics for these accidents were identified by Cox regression analysis.
  
  
  RESULTS
  Within a mean follow-up of 4.3years, traffic injury occurred significantly more often in patients with AF (N=1724) than those without it (N=6896) (5.4 vs. 4.9 per 1000 person-years, log-rank p=0.012, HR 1.110, 95% CI 1.013-1.572). Cox models identified age ≧65years, hypertension, coronary artery disease, stroke, liver cirrhosis and CHADS2VASC score≧1 as risk factors for traffic injury in AF patients, whereas oral anticoagulants (HR 0.576, 95% CI 0.285-0.791, p=0.002) used in patients with CHADS2VASC score ≧1 but not antiplatelet therapy (p=0.197) as negative predictors.
  
  
  CONCLUSIONS
  Patients with AF are more vulnerable to traffic accidents especially when with higher CHADS2VASC scores and other comorbidities. This tendency to traffic accidents, however, could be ameliorated by oral anticoagulation in specialized cases but not by antiplatelet therapy.
authors.affiliation: Department of Anesthesiology, Taichung Veterans General Hospital, Taiwan; Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Critical Care, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Surgery, National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Hui-Chin
authors.initials: HC
authors.lastname: Lai
authors.affiliation: School of Public Health, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Wu-Chien
authors.initials: WC
authors.lastname: Chien
authors.affiliation: Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan.
authors.forename: Chi-Hsiang
authors.initials: CH
authors.lastname: Chung
authors.affiliation: Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Wen-Lieng
authors.initials: WL
authors.lastname: Lee
authors.affiliation: Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Medicine, Chung-Shan Medical University School of Medicine, Taichung, Taiwan.
authors.forename: Kuo-Yang
authors.initials: KY
authors.lastname: Wang
authors.affiliation: Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Tsu-Juey
authors.initials: TJ
authors.lastname: Wu
authors.affiliation: Taipei First Girls High School, Taiwan.
authors.forename: Chia-Ning
authors.initials: CN
authors.lastname: Liu
authors.affiliation: Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Medicine, Chung-Shan Medical University School of Medicine, Taichung, Taiwan. Electronic address: trliu@vghtc.gov.tw.
authors.forename: Tsun-Jui
authors.initials: TJ
authors.lastname: Liu
mesh_terms: D000063:Accidents, Traffic / Q000639:trends*; D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006760:Hospitalization / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents
keywords: Anticoagulant; Antiplatelet; Atrial fibrillation; CHA2DS2-VASc; Traffic accident; Trauma