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Original Research: Cardiovascular Disease |

Effect of Active Smoking on Comparative Efficacy of Antithrombotic Therapy in Patients With Atrial FibrillationActive Smoking and Atrial Fibrillation: The Loire Valley Atrial Fibrillation Project

Denis Angoulvant, MD; Olivier Villejoubert, MD; Theodora Bejan-Angoulvant, MD; Fabrice Ivanes, MD; Christophe Saint Etienne, MD; Gregory Y. H. Lip, MD; Laurent Fauchier, MD
Author and Funding Information

From the Service de Cardiologie (Drs Angoulvant, Villejoubert, Bejan-Angoulvant, Ivanes, Saint Etienne, and Fauchier), Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France; and the University of Birmingham Centre for Cardiovascular Sciences (Dr Lip), City Hospital, Birmingham, England.

CORRESPONDENCE TO: Laurent Fauchier, MD, Service de Cardiologie et Laboratoire d’Electrophysiologie Cardiaque, Centre Hospitalier Universitaire Trousseau, 37044 Tours, France; e-mail: lfau@med.univ-tours.fr


Drs Lip and Fauchier were the joint senior authors of this manuscript.

FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(2):491-498. doi:10.1378/chest.14-3006
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BACKGROUND:  Active smoking is associated with elevated thrombotic risk. Smoking status has recently been incorporated into the SAMe-TT2R2 (sex female, age < 60 years, medical history [more than two comorbidities], treatment [interacting drugs, eg, amiodarone for rhythm control], tobacco use [doubled], race [doubled]) score that can help predict poor international normalized ratio control in patients with atrial fibrillation (AF) treated with vitamin K antagonists (VKAs). The clinical benefit of antiplatelet therapy (APT) has been seen primarily in smokers. We hypothesized that active smoking may differently influence the risks of stroke and bleeding in patients with AF treated with VKAs or with APT.

METHODS:  We examined the clinical course of 7,809 consecutive patients with AF seen between 2000 and 2010. Outcomes in patients who were active smokers were compared with those in other patients.

RESULTS:  Among 7,809 patients with AF, 1,034 (13%) were active smokers. APT was prescribed on an individual basis for 2,761 patients (35%) and VKAs for 4,534 (57%). After a follow-up of 929 ± 1,082 days (median = 463 days, interquartile range = 1,564 days), smoking was not independently associated with a higher risk of stroke/thromboembolic event in patients with AF (hazard ratio [HR], 0.95; 95% CI, 0.78-1.22; P = .66). On multivariate analysis, smoking was independently associated with a worse prognosis for the risk of severe bleeding (HR, 1.23; 95% CI, 1.01-1.49; P = .04) and for the risk of major Bleeding Academic Research Consortium bleeding (HR, 1.40; 95% CI, 1.02-1.90; P = .03). Smoking was independently associated with a higher risk of bleeding in patients treated with VKAs (HR, 1.32; 95% CI, 1.04-1.67; P = .02), whereas the risk was nonsignificant in patients treated with APT (HR, 1.28; 95% CI, 0.94-1.74; P = .11).

CONCLUSIONS:  In AF, there was a higher risk of severe bleeding in smokers, mainly in those treated with VKAs.

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