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.

中文翻译：

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房颤患者创伤性损伤后恢复口服抗凝治疗和卒中和出血风险：一项全国性队列研究

目的 我们研究了与房颤 (AF) 患者创伤性损伤后维生素 K 拮抗剂 (VKA) 和非 VKA 口服抗凝剂 (NOAC) 恢复相关的全因死亡、中风、大出血和复发性创伤性损伤的风险。方法和结果 这是一项丹麦全国登记研究（2005-16），包括 4541 名接受口服抗凝剂 (OAC) 治疗的 AF 患者，这些患者经历了外伤性损伤（定义为外伤性脑损伤、髋部骨折或外伤性躯干或腹部损伤）。外伤出院后 90 天内，60.6% 恢复 VKA（中位年龄 = 80，CHA2DS2-VASc = 4，HAS-BLED = 2），16.7% 恢复 NOAC（中位年龄 = 81，CHA2DS2-VASc = 4，HAS- BLED = 2)，22.7% 未恢复 OAC 治疗（中位年龄 = 81，CHA2DS2-VASc = 4，HAS-BLED = 3）。从 VKA 切换到 NOAC 的发生率为 9.5%。自 2009 年以来，OAC 恢复的趋势增加（P 值 <0.0001），尤其是 NOAC（P 值 <0.0001）。出院后 90 天开始随访，并使用时变多元 Cox 回归分析进行比较。与未恢复相比，恢复 VKA 和 NOAC 与较低的全因死亡率风险 [95% 置信区间 (CI)] 相关 [风险比 (HR) 0.48 (0.42-0.53) 和 HR 0.55 (0.47-0.66)， ] 和缺血性卒中 [分别为 HR 0.56 (0.43-0.72) 和 HR 0.54 (0.35-0.82)]，增加大出血风险 [分别为 HR 1.30 (1.03-1.64) 和 HR 1.15 (0.81-1.63)]，以及类似的复发性外伤风险 [分别为 HR 0.93 (0.73-1.18) 和 HR 0.87 (0.60-1.27)]。结论 AF 患者外伤后恢复 VKA 和 NOAC 治疗的全因死亡率和缺血性卒中风险较低，大出血风险增加，但没有额外的外伤复发风险。在 AF 患者发生外伤后停用 OAC 可能没有必要。数字。没有可用的字幕。