{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T23:05:58Z","timestamp":1740179158672,"version":"3.37.3"},"reference-count":28,"publisher":"Georg Thieme Verlag KG","issue":"01","license":[{"start":{"date-parts":[[2023,11,1]],"date-time":"2023-11-01T00:00:00Z","timestamp":1698796800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"AFFECT EU consortium\/European Union's Horizon 2020 research and innovation programme","award":["847770"],"award-info":[{"award-number":["847770"]}]},{"name":"Aalborg University Talent Management Programme","award":["no grant number"],"award-info":[{"award-number":["no grant number"]}]},{"DOI":"10.13039\/100007405","name":"Hjerteforeningen","doi-asserted-by":"crossref","award":["11-04-R83-A3363-22625"],"award-info":[{"award-number":["11-04-R83-A3363-22625"]}],"id":[{"id":"10.13039\/100007405","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100016303","name":"Medtronic Foundation","doi-asserted-by":"crossref","award":["No grant number"],"award-info":[{"award-number":["No grant number"]}],"id":[{"id":"10.13039\/100016303","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100012774","name":"Innovationsfonden","doi-asserted-by":"crossref","award":["12-135225"],"award-info":[{"award-number":["12-135225"]}],"id":[{"id":"10.13039\/100012774","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100008276","name":"Skibsreder Per Henriksen, R. og hustrus fond","doi-asserted-by":"crossref","award":["No grant number"],"award-info":[{"award-number":["No grant number"]}],"id":[{"id":"10.13039\/501100008276","id-type":"DOI","asserted-by":"crossref"}]},{"name":"The Reasearch Foundation for the Capital Region of Denmark","award":["no grant number"],"award-info":[{"award-number":["no grant number"]}]},{"DOI":"10.13039\/100007460","name":"Arvid Nilssons Fond","doi-asserted-by":"crossref","award":["No grant number"],"award-info":[{"award-number":["No grant number"]}],"id":[{"id":"10.13039\/100007460","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TH Open"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:p>\n            Background\u2003Atrial fibrillation (AF) prevalence is rising; however, data on the bleeding risks associated with the detection of subclinical AF are needed.<\/jats:p><jats:p>\n            Objective\u2003Our objective was to determine the bleeding increment associated with implantable loop recorder (ILR) screening for subclinical AF and subsequent anticoagulation initiation compared with usual care.<\/jats:p><jats:p>\n            Methods\u2003This post hoc study utilized LOOP trial data from 6,004 elderly patients with stroke risks randomized to either ILR (n\u2009=\u20091,503) or usual care (n\u2009=\u20094,503). The mean follow-up time was 64.5 months, and none were lost to follow-up. The primary exposure was the initiation of oral anticoagulation, and the main outcome was the risk of major bleeding events following initiation of oral anticoagulants (OACs), determined by time-dependent cox regression. Second, we investigated antithrombotic prescription patterns and major bleeding events after antiplatelet treatment and in subgroups.<\/jats:p><jats:p>\n            Results\u2003OAC was initiated in 1,019 participants with a mean age (years) of 78.8 (\u00b1\u20094.67) in control versus 77.0 (\u00b1\u20094.84) in ILR, p\u2009&lt;\u20090.0001. Altogether did 202 participants end or pause OAC treatment. Among AF patients (n\u2009=\u2009910) had 40 (28%) completely ended OAC and 105 (72%) temporarily paused OAC during follow-up. Major bleeding events totaled 221 (3.7%). Forty-seven major bleeding events followed an OAC initiation in 1,019 participants (4.6%); 26 versus 21 events in the control and ILR groups, respectively. The hazard ratio (HR) for major bleeding after OAC initiation compared with before initiation was 2.08 (1.50\u20132.90) p\u2009&lt;\u20090.0001 overall, 2.81 (1.82\u20134.34) p\u2009&lt;\u20090.0001 for control and 1.32 (0.78\u20132.23) p\u2009=\u20090.31 for the ILR group (p\u2009=\u20090.07 for interaction). Antiplatelet treatment resulted in an overall adjusted HR of 1.3 (0.96\u20131.75) p\u2009=\u20090.09. For OAC users aged \u226575 years in the ILR group, the rate of major bleeding was 1.73 (0.92\u20132.96) compared with 0.84 (0.36\u20131.66) for an age &lt;75 years, and the rate of the corresponding control subgroup aged \u226575 years was 2.20 (1.23\u20133.63) compared with 1.64 (0.82\u20132.93) for an age &lt;75 years.<\/jats:p><jats:p>\n            Conclusion\u2003The individual risk of major bleeding increased twofold after initiation of oral anticoagulation for all patients in this study. However, the patients screened for subclinical AF did not have a higher bleeding risk after initiation of anticoagulation compared with those in usual care.<\/jats:p><jats:p>\n            Trial Registration:\u2003The LOOP study is registered at ClinicalTrials.gov, identifier: NCT020364 50<\/jats:p>","DOI":"10.1055\/a-2202-4296","type":"journal-article","created":{"date-parts":[[2023,11,2]],"date-time":"2023-11-02T00:07:37Z","timestamp":1698883657000},"page":"e19-e30","source":"Crossref","is-referenced-by-count":5,"title":["Anticoagulation-Associated Bleeding in Patients Screened for Atrial Fibrillation versus Usual Care\u2014A Post Hoc Analysis from the LOOP Study"],"prefix":"10.1055","volume":"08","clinical-trial-number":[{"clinical-trial-number":"nct02036450","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0579-3276","authenticated-orcid":false,"given":"Emilie Katrine","family":"Kongebro","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Copenhagen University Hospital\u2014Rigshospitalet, Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S\u00f8ren Z\u00f6ga","family":"Diederichsen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Copenhagen University Hospital\u2014Rigshospitalet, Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucas Yixi","family":"Xing","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Copenhagen University Hospital\u2014Rigshospitalet, Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ketil J\u00f8rgen","family":"Haugan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claus","family":"Graff","sequence":"additional","affiliation":[{"name":"Department of Health Science and Technology, Aalborg University, Aalborg, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S\u00f8ren","family":"H\u00f8jberg","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Morten S.","family":"Olesen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Copenhagen University Hospital\u2014Rigshospitalet, Copenhagen, Denmark"},{"name":"Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Derk","family":"Krieger","sequence":"additional","affiliation":[{"name":"Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Healthcare City, Dubai, United Arab Emirates"},{"name":"Department of Neurology, Mediclinic Parkview Hospital, Al Barsha South, Dubai, United Arab Emirates"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Axel","family":"Brandes","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Odense University Hospital, Odense, Denmark"},{"name":"Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense C, Denmark"},{"name":"Department of Cardiology, University Hospital of Southern Denmark\u2014Esbjerg, Esbjerg, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lars","family":"K\u00f8ber","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Copenhagen University Hospital\u2014Rigshospitalet, Copenhagen, Denmark"},{"name":"Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jesper Hastrup","family":"Svendsen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Copenhagen University Hospital\u2014Rigshospitalet, Copenhagen, Denmark"},{"name":"Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,1,8]]},"reference":[{"issue":"05","key":"ref1","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC","volume":"42","author":"G Hindricks","year":"2021","journal-title":"Eur Heart J"},{"issue":"06","key":"ref2","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1161\/CIRCULATIONAHA.118.036248","article-title":"Major bleeding rates in atrial fibrillation patients on single, dual, or triple antithrombotic therapy","volume":"139","author":"N van Rein","year":"2019","journal-title":"Circulation"},{"issue":"35","key":"ref3","doi-asserted-by":"crossref","first-page":"2746","DOI":"10.1093\/eurheartj\/eht280","article-title":"Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060","volume":"34","author":"B P Krijthe","year":"2013","journal-title":"Eur Heart J"},{"issue":"10","key":"ref4","doi-asserted-by":"crossref","first-page":"1612","DOI":"10.1093\/europace\/euab065","article-title":"2021 European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation","volume":"23","author":"J Steffel","year":"2021","journal-title":"Europace"},{"issue":"20","key":"ref5","first-page":"2141","article-title":"Major bleeding in patients with atrial fibrillation receiving apixaban or warfarin: The ARISTOTLE trial (Apixaban for reduction in stroke and other thromboembolic events in atrial fibrillation): predictors, characteristics, and clinical outcomes","volume":"63","author":"E M Hylek","year":"2014","journal-title":"J Am Coll Cardiol"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"1507","DOI":"10.1016\/S0140-6736(21)01698-6","article-title":"Implantable loop recorder detection of atrial fibrillation to prevent stroke (The LOOP Study): a randomised controlled trial","volume":"398","author":"J H Svendsen","year":"2021","journal-title":"Lancet"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.ahj.2017.02.017","article-title":"Atrial fibrillation detected by continuous electrocardiographic monitoring using implantable loop recorder to prevent stroke in individuals at risk (the LOOP study): rationale and design of a large randomized controlled trial","volume":"187","author":"S Z Diederichsen","year":"2017","journal-title":"Am Heart J"},{"issue":"04","key":"ref8","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1111\/j.1538-7836.2005.01204.x","article-title":"Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients","volume":"3","author":"S Schulman","year":"2005","journal-title":"J Thromb Haemost"},{"issue":"22","key":"ref9","doi-asserted-by":"crossref","first-page":"2771","DOI":"10.1016\/j.jacc.2019.09.050","article-title":"Natural history of subclinical atrial fibrillation detected by implanted loop recorders","volume":"74","author":"S Z Diederichsen","year":"2019","journal-title":"J Am Coll Cardiol"},{"issue":"07","key":"ref10","doi-asserted-by":"crossref","first-page":"1448","DOI":"10.1160\/TH16-12-0961","article-title":"Cessation of oral anticoagulation is an important risk factor for stroke and mortality in atrial fibrillation patients","volume":"117","author":"J M Rivera-Caravaca","year":"2017","journal-title":"Thromb Haemost"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"f72","DOI":"10.1093\/ehjcvp\/pvaa017","article-title":"Long-term persistence and adherence with non-vitamin K oral anticoagulants in patients with atrial fibrillation and their associations with stroke risk","volume":"7","author":"J J Komen","year":"2021","journal-title":"Eur Heart J Cardiovasc Pharmacother"},{"issue":"16","key":"ref12","doi-asserted-by":"crossref","first-page":"1519","DOI":"10.1056\/NEJMoa1803955","article-title":"Effect of aspirin on all-cause mortality in the healthy elderly","volume":"379","author":"J J McNeil","year":"2018","journal-title":"N Engl J Med"},{"issue":"16","key":"ref13","doi-asserted-by":"crossref","first-page":"1577","DOI":"10.1001\/jama.2022.4983","article-title":"Aspirin use to prevent cardiovascular disease: US Preventive Services Task Force Recommendation Statement","volume":"327","author":"K W Davidson","year":"2022","journal-title":"JAMA"},{"issue":"01","key":"ref14","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1186\/s13063-022-06803-x","article-title":"Examining evidence of time-dependent treatment effects: an illustration using regression methods","volume":"23","author":"K M Jachno","year":"2022","journal-title":"Trials"},{"issue":"13","key":"ref15","doi-asserted-by":"crossref","first-page":"1167","DOI":"10.1056\/NEJMoa2303062","article-title":"Anticoagulation with Edoxaban in patients with atrial high-rate episodes","volume":"389","author":"P Kirchhof","year":"2023","journal-title":"N Engl J Med"},{"issue":"16","key":"ref16","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.1001\/archinternmed.2010.271","article-title":"Risk of bleeding with single, dual, or triple therapy with warfarin, aspirin, and clopidogrel in patients with atrial fibrillation","volume":"170","author":"M L Hansen","year":"2010","journal-title":"Arch Intern Med"},{"issue":"01","key":"ref17","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1161\/CIRCULATIONAHA.119.041296","article-title":"Patients with atrial fibrillation taking nonsteroidal anti-inflammatory drugs and oral anticoagulants in the ARISTOTLE Trial","volume":"141","author":"F Dalgaard","year":"2020","journal-title":"Circulation"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"1498","DOI":"10.1016\/S0140-6736(21)01637-8","article-title":"Clinical outcomes in systematic screening for atrial fibrillation (STROKESTOP): a multicentre, parallel group, unmasked, randomised controlled trial","volume":"398","author":"E Svennberg","year":"2021","journal-title":"Lancet"},{"issue":"02","key":"ref19","doi-asserted-by":"crossref","first-page":"e004517","DOI":"10.1161\/JAHA.116.004517","article-title":"Major bleeding complications and persistence with oral anticoagulation in non-valvular atrial fibrillation: contemporary findings in real-life Danish patients","volume":"6","author":"M Lamberts","year":"2017","journal-title":"J Am Heart Assoc"},{"issue":"01","key":"ref20","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1111\/bcp.14961","article-title":"Number needed to treat for net effect of anticoagulation in atrial fibrillation: Real-world vs. clinical-trial evidence","volume":"88","author":"W Y Ding","year":"2022","journal-title":"Br J Clin Pharmacol"},{"issue":"07","key":"ref21","doi-asserted-by":"crossref","first-page":"e005657","DOI":"10.1161\/JAHA.117.005657","article-title":"Thromboembolic risk, bleeding outcomes and effect of different antithrombotic strategies in very elderly patients with atrial fibrillation: a sub-analysis from the PREFER in AF (PREvention oF Thromboembolic Events-European Registry in Atrial Fibrillation)","volume":"6","author":"G Patti","year":"2017","journal-title":"J Am Heart Assoc"},{"issue":"09","key":"ref22","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1055\/a-1336-0476","article-title":"Age-dependent anticoagulant therapy for atrial fibrillation patients with intermediate risk of ischemic stroke: a nationwide population-based study","volume":"121","author":"S Y Choi","year":"2021","journal-title":"Thromb Haemost"},{"issue":"02","key":"ref23","doi-asserted-by":"crossref","first-page":"e0263903","DOI":"10.1371\/journal.pone.0263903","article-title":"Contemporary clinical and economic outcomes among oral anticoagulant treated and untreated elderly patients with atrial fibrillation: Insights from the United States Medicare database","volume":"17","author":"M B Munir","year":"2022","journal-title":"PLoS One"},{"key":"ref24","first-page":"1","article-title":"National population projections: 2020-based interim","author":"J Robards","year":"2022"},{"issue":"187","key":"ref25","first-page":"2021","article-title":"News from Statistics Denmark\u2014Population growth highest in the elderly population","year":"2021"},{"issue":"05","key":"ref26","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1007\/s00392-021-01941-9","article-title":"Mobile health solutions for atrial fibrillation detection and management: a systematic review","volume":"111","author":"A NL Hermans","year":"2022","journal-title":"Clin Res Cardiol"},{"issue":"04","key":"ref27","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1111\/joim.13217","article-title":"Large-scale screening studies for atrial fibrillation\u2014is it worth the effort?","volume":"289","author":"J Engdahl","year":"2021","journal-title":"J Intern Med"},{"issue":"09","key":"ref28","doi-asserted-by":"crossref","first-page":"euad226","DOI":"10.1093\/europace\/euad226","article-title":"Atrial fibrillation and stroke prevention: 25 years of research at EP Europace journal","volume":"25","author":"G YH Lip","year":"2023","journal-title":"Europace"}],"container-title":["TH Open"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2202-4296.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T13:11:46Z","timestamp":1730812306000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2202-4296"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,1]]},"references-count":28,"journal-issue":{"issue":"01","published-online":{"date-parts":[[2024,1,8]]},"published-print":{"date-parts":[[2024,1]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2202-4296","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2512-9465"],"issn-type":[{"type":"electronic","value":"2512-9465"}],"subject":[],"published-other":{"date-parts":[[2023,11,1]]},"published":{"date-parts":[[2023,11,1]]}}}