MedicalResearch.com Interview with:
Dr. William Frank Peacock MD, FACEP
Baylor College of Medicine, Houston
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Peacock: Patients with atrial fibrillation get strokes but can take anticoagulation which is very effective at preventing strokes.
Patients on anticoagulation bleed, to the point that a very few die.
The higher the CHADSVASC score, the more likely you are to have a stroke.
Also the more likely you are to bleed.
But the risk of stroke ALWAYS exceeds the risk of bleeding.
We studied diabetics with atrial fibrillation as a subset, because diabetes is significant predictor for both stroke and bleeding and we wanted to determine if our understanding of the risks and benefits were maintained in real world trial.
What we found was the risk of a fatal major bleed for a diabetic with atrial fibrillation who was taking rivaroxaban was 0.09/100 patient years of treatment.
We know that the risk of having a stroke in a patient with a CHADS score of 2 is about 3% per year (that is 3/100 patients will stroke).
Put in a similar denominator as our study, failing to treat an Afib diabetic will results 300 strokes for every 100 patient years, which compares to the effect of treatment, which will significantly prevent stroke, at the cost of 0.1 major bleed fatality per 100 patient years. Even if the effect of treatment was as low as 50% (which it is not), that is still preventing 150 strokes.
0.1 dead, to prevent 150 strokes seems like easy math to me.
MedicalResearch.com: What should clinicians and patients take away from your report?
Dr. Peacock: Diabetics with atrial fibrillation have significant benefit from treatment, with very few iatrogenic complications.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Peacock: Further investigations regarding race, BMI and outcomes are required. We don’t have great guidance or knowledge on how to adjust medications appropriately in the morbidly obese, and we have little understanding if racial differences have an outcome impact.
MedicalResearch.com: Is there anything else you would like to add?
Dr. Peacock: Don’t get preventable diseases.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Patel MR, Tamayo S, Yuan Z, Sicignano N, Hopf K, Peacock F. MAJOR BLEEDING AMONG RIVAROXABAN USERS WITH NONVALVULAR ATRIAL FIBRILLATION AND DIABETES. J Am Coll Cardiol. 2016;67(13_S):733. doi:10.1016/S0735-1097(16)30734-3.
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