title: Atrial fibrillation, liver disease, antithrombotics and risk of cerebrovascular events: A population-based cohort study.
abstract: BACKGROUND
  Whether patients with atrial fibrillation (AF) and liver disease are also prone to cerebrovascular events and respond similarly favorably to antithrombotic therapy remains under-investigated.
  
  
  METHODS
  Patients ≥18years with newly-diagnosed AF in the period 2005 to 2009 were scrutinized from the "Longitudinal Health Insurance Database 2005" (1 million beneficiaries) of Taiwan's National Health Insurance Institute. Patients were categorized into the Liver (N=433) or the Non-liver (N=3490) cohort according to whether they had a diagnosis of advanced liver disease. Patients were then followed to determine cumulative incidence of hospitalization-requiring cerebrovascular events, preventive effects of antithrombotics, and predictors of cerebrovascular events by Cox regression analysis.
  
  
  RESULTS
  Within a mean follow-up of 3.3±1.4years, ischemic stroke (89.2 vs. 50.3 per 1000 person-years, adjusted HR 1.502, 95% CI 1.207-1.868, p<0.001) and overall cerebrovascular events (102.3 vs. 56.4 per 1000 person-years, adjusted HR 1.535, 95% CI 1.251-1.883, p<0.001) occurred significantly more often in the Liver than in the Non-liver cohort. Cox models identified aging (≥65years), DM, and CHA2DS-VASc score≥2 points as risk factors for overall cerebrovascular events in the Liver cohort, whereas antiplatelet agents (HR 0.932, 95% CI 0.128-6.803, p=NS) and vit-K antagonistic anticoagulants (HR 1.087, 95% CI 0.150-7.862, p=NS) showed no correlation.
  
  
  CONCLUSIONS
  AF patients comorbid with advanced liver disease are more vulnerable to ischemic and therein overall cerebrovascular events, especially in those with old age, DM, or high CHA2DS-VASc scores. This propensity to cerebrovascular events, however, can't be altered by antithrombotic therapy.
authors: Cardiovascular Center and Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan; Departments of Medicine and Surgery, National Yang-Ming University School of Medicine, Taipei.
authors: Hui-Chin
authors: HC
authors: Lai
authors: School of Public Health and Tri-Service General Hospital Department of Medical Research, National Defense Medical Center, Taipei.
authors: Wu-Chien
authors: WC
authors: Chien
authors: Taiwanese Injury Prevention and Safety Promotion Association, Taipei.
authors: Chi-Hsiang
authors: CH
authors: Chung
authors: Cardiovascular Center and Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan; Departments of Medicine and Surgery, National Yang-Ming University School of Medicine, Taipei.
authors: Wen-Lieng
authors: WL
authors: Lee
authors: Cardiovascular Center and Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan; Departments of Medicine and Surgery, National Yang-Ming University School of Medicine, Taipei.
authors: Tsu-Juey
authors: TJ
authors: Wu
authors: Cardiovascular Center and Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Medicine, Chung Shan Medical University School of Medicine, Taichung, Taiwan.
authors: Kuo-Yang
authors: KY
authors: Wang
authors: Departments of Medicine and Surgery, National Yang-Ming University School of Medicine, Taipei.
authors: Chia-Ning
authors: CN
authors: Liu
authors: Cardiovascular Center and Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan; Departments of Medicine and Surgery, National Yang-Ming University School of Medicine, Taipei; China Medical University, Taichung, Taiwan. Electronic address: trliu@vghtc.gov.tw.
authors: Tsun-Jui
authors: TJ
authors: Liu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology
chemical_list: D005343:Fibrinolytic Agents
keywords: Antithrombotic; Atrial fibrillation; CHA2DS2-VASc; Cerebrovascular; Liver; Stroke