Effect of active smoking on comparative efficacy of antithrombotic therapy in patients with atrial fibrillation: The Loire Valley Atrial Fibrillation Project.
Chest. 2015 Mar 26;
Authors: Angoulvant D, Villejoubert O, Bejan Angoulvant T, Ivanes F, Etienne CS, Lip GY, Fauchier L
Background: Active smoking is associated with elevated thrombotic risk. Smoking status has recently been incorporated into the SAMe-TT2R2 score that can help predict poor INR control in patients with atrial fibrillation (AF) treated with vitamin K antagonists (VKA). The clinical benefit of antiplatelet therapy (APT) has been seen primarily in smokers. We hypothesised that active smoking may differently influence the risks of stroke and bleeding in AF patients treated with VKA or with APT.
Methods: We examined the clinical course of 7809 consecutive patients with AF seen between 2000-2010. Outcomes in patients with active smoking were compared with those in other patients.
Results: Among 7809 patients with AF, 1034(13%) were actively smoking. APT was prescribed on an individual basis for 2761 patients (35%) and VKA in 4534 (57%). After a follow-up of 929±1082 days (median=463 days, interquartile range=1564 days), smoking was not independently associated with a higher risk of stroke/TE in AF patients (hazard ratio (HR) 0.95, 95%CI 0.78-1.22, p=0.66). On multivariate analysis, smoking was independently associated with a worse prognosis for the risk of severe bleeding (HR 1.23, 95%CI 1.01-1.49, p=0.04) and for the risk of major BARC bleeding (HR 1.40, 95%CI 1.02-1.90, p=0.03). Smoking was independently associated with a higher risk of bleeding in patients treated with VKA (HR 1.32, 95%CI 1.04-1.67; p=0.02) whilst the risk was non- significant in patients treated with APT (HR 1.28, 95%CI 0.94-1.74; p=0.11).
Conclusion: In AF, there was a higher risk of severe bleeding in smokers, mainly in those treated with VKA.
PMID: 25812113 [PubMed - as supplied by publisher]