COPD, Atrial Fibrillation, and Anticoagulation

A recent study showed chronic obstructive pulmonary disease (COPD) increased risk of cardiovascular deaths and all-cause mortality in atrial fibrillation (AF) patients, but also suggested the presence of COPD should not impact which anticoagulant is used to manage abnormal heart rhythms.

The researchers revisited the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial, which compared the impact of warfarin and apixaban on risks of stroke, systemic embolism, and bleeding in more than 18,000 AF patients.

According to the study, the 1,950 patients who showed signs of COPD were older men who smoked or had at one time. They were also more likely to have significant comorbidities that increased risk of stroke, including elevated CHAD2 scores, coronary artery disease, and history of heart attack or heart failure.

The researchers said COPD did not increase risk of stroke or systemic embolism, but did heighten all-cause mortality and cardiovascular death by 54%. Importantly, the use of warfarin and apixaban did not impact stroke or systemic embolism risk in patients with or without COPD.

COPD is associated with poor outcomes in patients with cardiovascular disease, but less is known about the disease’s impact on patients with AF.

“Other studies have shown that COPD is an independent risk factor for cardiovascular disease, but what hadn’t been studied was whether COPD was an independent risk factor for stroke, specifically among patients with atrial fibrillation,” said study lead author Dr. Michael Durheim, a pulmonary and critical care fellow at Duke University.

Although COPD increased risk of mortality in AF patients, Dr. Durheim said further studies are needed to determine exactly why that occurred before clinical practices are altered.

In the meantime, he added, “The presence of COPD doesn't need to affect provider’s choice of an anticoagulant.”

The ARISTOTLE trial was sponsored by Bristol-Myers Squibb and Pfizer.

—Dan Cook

Reference:

1. Durheim MT, Cyr DD, Al-Khatib SM, et al. Chronic obstructive pulmonary disease Is associated with increased risk of mortality among patients with atrial fibrillation: insights from the ARISTOTLE trial. AJRCCM Conference, meeting abstracts. 2015 May 6 [Epub ahead of print]