Digoxin use is associated with increased risk of stroke in patients with non-valvular atrial fibrillation — a nationwide population-based cohort study

Atrial fibrillation (AF) is associated with increased risk of morbidity and mortality. Digoxin is often used as a rate control agent in AF patients, particularly in those with systolic heart failure. Although digoxin use in AF patients can reduce heart failure symptoms, increase exercise capacity and decrease hospitalizations , unfavorable effects on long-term outcomes have been reported . In the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study, a post-hoc analysis showed a higher rate of mortality in patients treated with digitalis medication . A study of the “Registry of Information and Knowledge about Swedish Heart Intensive care Admissions” (RIKS-HIA) demonstrated that AF patients without heart failure had a higher mortality rate if they were treated with digoxin . The use of digoxin in non-valvular AF patients has been associated with increased platelet and endothelial cell activation , and the digitalis-mediated platelet activation has been attributed to its intensification of the intracellular calcium concentrations . Thus, it is conceivable that the effects of endothelial and platelet activation as a consequence of digoxin treatment may enhance the risk of stroke in AF patients, which can be further linked to higher mortality rates observed in previous studies . Therefore, we sought to investigate the risk of stroke among AF patients with and without digoxin use in an Asian cohort of 982,232 patients covered by the universal health i...
Source: International Journal of Cardiology - Category: Cardiology Authors: Tags: Online Letters to the Editor Source Type: research