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Background and Purpose -In patients with atrial fibrillation (AF), oral anticoagulant therapy (OAT) is effective in reducing stroke and embolism. However, despite OAT, ischemic events do occur in some patients. Studies specifically addressing the identification of risk factors for ischemic events during well-conducted OAT are not available. In this study, we prospectively investigated the role of classic risk factors and homocysteine levels in the occurrence of ischemic complications in 364 AF patients on OAT. Methods -The quality of anticoagulation levels and the occurrence of bleeding and thrombotic events were recorded. Results -During follow-up (859 patient years) 21 patients had ischemic complicatio ns (rate 2.4×100 patient-years). Homocysteine plasma levels were higher in the se patients than in patients without ischemic complications during OAT (P < 0.01 ), whereas no difference was observed in relation to the quality of OAT. The pre sence of a history of previous ischemic events, hypertension, and homocysteine p lasma levels over the 90th percentile were all associated with an increased risk of ischemic events during OAT (odds ratio [OR]=7, 4.5, and 4.7, respectively) . The coexistence of these risk factors markedly increased the risk (OR=13.1; 95% CI, 3.7 to 45.7; P=0.001). Conclusion -In conclusion, our results indicate that AF patients with multiple risk factors may not be sufficiently protected by OAT , even when this is well conducted.
Background and Purpose -In patients with atrial fibrillation (AF), oral anticoagulant therapy (OAT) is effective in reducing stroke and embolism. However, despite OAT, ischemic events do occur in some patients. Studies specifically address the identification of risk factors for ischemic events during well-conducted OAT are not available. In this study, we prospectively investigated the role of classic risk factors and homocysteine levels in the occurrence of ischemic complications in 364 AF patients on OAT. Methods-The quality of anticoagulation levels and the occurrence of Homocysteine plasma levels were higher in the se patients than in patients without ischemic complications during a follow-up (859 patient years) 21 patients had ischemic complicatio ns (rate 2.4 × 100 patient-years) The no difference was observed in relation to the quality of OAT. The pre sence of a history of previous ischemic even (P <0.01) ts, hypertension, and homocysteine p lasma levels over the 90th percentile were all associated with an increased risk of ischemic events during OAT (odds ratio [OR] = 7, 4.5, and 4.7, respectively). The coexistence of these risk factors markedly increased Conclusion -In conclusion, our results indicate that AF patients with multiple risk factors may not be illuminated protected by OAT, even when this is well conducted. The risk (OR = 13.1; 95% CI, 3.7 to 45.7;