title: Assessment of Use vs Discontinuation of Oral Anticoagulation After Pulmonary Vein Isolation in Patients With Atrial Fibrillation.
abstract: Pulmonary vein isolation (PVI) is a recommended treatment for patients with atrial fibrillation, but it is unclear whether it results in a lower risk of stroke.
  
  
  
  To investigate the proportion of patients discontinuing anticoagulation treatment after PVI in association with the CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years [doubled], diabetes, stroke [doubled], vascular disease, age 65-74 years, sex category [female]) score, identify factors predicting stroke after PVI, and explore the risk of cardiovascular events after PVI in patients with and without guideline-recommended anticoagulation treatment.
  
  
  
  A retrospective cohort study was conducted using Swedish national health registries from January 1, 2006, to December 31, 2012, with a mean-follow up of 2.6 years. A total of 1585 patients with atrial fibrillation undergoing PVI from the Swedish Catheter Ablation Register were included, with information about exposure to warfarin in the national quality register Auricula. Data analysis was performed from January 1, 2015, to April 30, 2016.
  
  
  
  Warfarin treatment.
  
  
  
  Ischemic stroke, intracranial hemorrhage, and death.
  
  
  
  In this cohort of 1585 patients, 73.0% were male, the mean (SD) age was 59.0 (9.4) years, and the mean (SD) CHA2DS2-VASc score was 1.5 (1.4). Of the 1585 patients, 1175 were followed up for more than 1 year after PVI. Of these, 360 (30.6%) discontinued warfarin treatment during the first year. In patients with a CHA2DS2-VASc score of 2 or more, patients discontinuing warfarin treatment had a higher rate of ischemic stroke (5 events in 312 years at risk [1.6% per year]) compared with those continuing warfarin treatment (4 events in 1192 years at risk [0.3% per year]) (P = .046). Patients with a CHA2DS2-VASc score of 2 or more or those who had previously experienced an ischemic stroke displayed a higher risk of stroke if warfarin treatment was discontinued (hazard ratio, 4.6; 95% CI, 1.2-17.2; P = .02 and hazard ratio, 13.7; 95% CI, 2.0-91.9; P = .007, respectively).
  
  
  
  These findings indicate that discontinuation of warfarin treatment after PVI is not safe in high-risk patients, especially those who have previously experienced an ischemic stroke.
authors.affiliation: Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
authors.forename: Sara
authors.initials: S
authors.lastname: Själander
authors.affiliation: Arrhythmia Clinic, Skåne University Hospital, Lund, Sweden3Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Holmqvist
authors.affiliation: Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden4Department of Heart Failure and Valvular Disease, Skåne University Hospital, Lund, Sweden.
authors.forename: J Gustav
authors.initials: JG
authors.lastname: Smith
authors.affiliation: Arrhythmia Clinic, Skåne University Hospital, Lund, Sweden3Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Pyotr G
authors.initials: PG
authors.lastname: Platonov
authors.affiliation: Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
authors.forename: Milos
authors.initials: M
authors.lastname: Kesek
authors.affiliation: Department for Coagulation Disorders, Lund University, Malmö, Sweden.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Svensson
authors.affiliation: Department of Cardiology, Institution of Medical Science, Uppsala University, Uppsala, Sweden.
authors.forename: Carina
authors.initials: C
authors.lastname: Blomström-Lundqvist
authors.affiliation: Department of Clinical Sciences, South Hospital, Karolinska Institute, Stockholm, Sweden8Arrhythmia Center Stockholm, Stockholm, Sweden.
authors.forename: Fariborz
authors.initials: F
authors.lastname: Tabrizi
authors.affiliation: Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Jari
authors.initials: J
authors.lastname: Tapanainen
authors.affiliation: Department of Cardiology, Faculty of Medicine and Health, Örebro University.
authors.forename: Dritan
authors.initials: D
authors.lastname: Poci
authors.affiliation: Department of Cardiology, Linköping University Hospital, Linköping, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Jönsson
authors.affiliation: Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Själander
mesh_terms: D000284:Administration, Oral; D000367:Age Factors; D000925:Anticoagulants / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D002545:Brain Ischemia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D017115:Catheter Ablation / Q000379:methods*; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011667:Pulmonary Veins / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D014859:Warfarin / Q000008:administration & dosage*; D028761:Withholding Treatment
chemical_list: D000925:Anticoagulants; D014859:Warfarin