Jalli Eero, Jaakkola Jussi, Langén Ville, Airaksinen K E Juhani, Halminen Olli, Putaala Jukka, Mustonen Pirjo, Haukka Jari, Hartikainen Juha, Linna Miika, Kouki Elis, Lehto Mika, Teppo Konsta
Division of Medicine, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20521 Turku, Finland.
Cardiac Unit, Department of Internal Medicine, Satasairaala, Pori, Finland.
Europace. 2025 Aug 4;27(8). doi: 10.1093/europace/euaf155.
Little is known about the association of venous thromboembolisms (VTEs) on the risk of ischaemic stroke (IS) in patients with atrial fibrillation (AF). Nevertheless, both pulmonary embolism (PE) and deep venous thromboembolism (DVT) are often included in the calculation of the CHA2DS2-VASc score, which is used for stroke risk stratification. Therefore, we conducted this nationwide retrospective cohort study to evaluate whether a history of VTE is associated with an increased risk of IS in patients with AF.
The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) registry-linkage study includes all patients in Finland with incident AF from 2007 to 2018. The IS rates and rate ratios were computed for patients with and without a history of VTE. We identified 271 500 patients with new-onset AF, of whom 4.6% had prior VTE, while 1.9% had a history of PE and 3.1% a history of DVT. The crude incidence of IS was slightly higher in patients with a history of VTE compared to patients without a history of VTE, but after adjusting for baseline factors, VTE was not associated with the rate of IS [adjusted incidence rate ratio with 95% confidence interval for any VTE 1.05 (0.98-1.13), for PE 1.01 (0.91-1.13), and for DVT 1.09 (1.00-1.18)]. There was no temporal change in these associations during the study period.
A history of VTEs was not associated with an increased risk of IS, suggesting that they do not need to be considered in the stroke risk stratification of patients with AF.
关于心房颤动（AF）患者静脉血栓栓塞症（VTE）与缺血性卒中（IS）风险之间的关联，目前所知甚少。然而，肺栓塞（PE）和深静脉血栓栓塞（DVT）通常都被纳入用于卒中风险分层的CHA2DS2-VASc评分的计算中。因此，我们开展了这项全国性回顾性队列研究，以评估VTE病史是否与AF患者发生IS的风险增加相关。
芬兰心房颤动抗凝治疗（FinACAF）注册链接研究纳入了2007年至2018年芬兰所有新发AF患者。计算有和没有VTE病史患者的IS发生率及发生率比值。我们确定了271500例新发AF患者，其中4.6%有既往VTE史，1.9%有PE史，3.1%有DVT史。有VTE病史的患者IS的粗发病率略高于无VTE病史的患者，但在对基线因素进行调整后，VTE与IS发生率无关[任何VTE的调整后发病率比值及95%置信区间为1.05（0.98 - 1.13），PE为1.01（0.91 - 1.13），DVT为1.09（1.00 - 1.18）]。在研究期间，这些关联没有时间上的变化。
VTE病史与IS风险增加无关，这表明在AF患者的卒中风险分层中无需考虑VTE病史。
