LAUSR

Aims We examined the risks of all‐cause mortality, stroke, major bleeding, and recurrent traumatic injury associated with resumption of vitamin K antagonists (VKAs) and non‐VKAs oral anticoagulants (NOACs) following traumatic injury in atrial fibrillation (AF) patients. Methods and results This was a Danish nationwide registry‐based study (2005‐16), including 4541 oral anticoagulant (OAC)‐treated AF patients experiencing traumatic injury (defined as traumatic brain injury, hip fracture, or traumatic torso or abdominal injury). Within 90 days following discharge from traumatic injury, 60.6% resumed VKA (median age = 80, CHA2DS2‐VASc = 4, HAS‐BLED = 2), 16.7% resumed NOAC (median age = 81, CHA2DS2‐VASc = 4, HAS‐BLED = 2), and 22.7% did not resume OAC treatment (median age = 81, CHA2DS2‐VASc = 4, HAS‐BLED = 3). Switch from VKA to NOAC occurred among 9.5%. Since 2009, the trend in OAC resumption increased (P‐value <0.0001), in particular with NOACs (P‐value <0.0001). Follow‐up started 90 days after discharge, and time‐varying multiple Cox regression analyses were used for comparisons. Compared with non‐resumption, VKA and NOAC resumption were associated with lower hazard [95% confidence interval (CI)] of all‐cause mortality [hazard ratio (HR) 0.48 (0.42‐0.53) and HR 0.55 (0.47‐0.66), respectively] and ischaemic stroke [HR 0.56 (0.43‐0.72) and HR 0.54 (0.35‐0.82), respectively], increased major bleeding hazard [HR 1.30 (1.03‐1.64) and HR 1.15 (0.81‐1.63), respectively], and similar hazard of recurrent traumatic injury [HR 0.93 (0.73‐1.18) and HR 0.87 (0.60‐1.27), respectively]. Conclusion AF patients resuming VKA and NOAC treatment following traumatic injury have lower hazard of all‐cause mortality and ischaemic stroke, increased hazard of major bleeding but without additional hazards of recurrent traumatic injury. Withholding OAC following a traumatic injury in AF patients may not be warranted. Figure. No Caption available.