Background

Stroke risk in Atrial fibrillation(AF) patients without anticoagulation is determined by the CHA2DS2-VASc-score. The aforementioned is the acronym for the major comorbidities that have an impact on developing a stroke. The aim of the study is to analyze the role of Bariatric surgery(BS) on the risk of stroke.

Methods

After IRB approval, we performed a retrospective analysis of all patients with BMI>35Kg/m2 from 2004 to 2019. Patients that had AF before BS(cases) and prior to Internal Medicine visit(controls) were included. Groups were matched by demographics and comorbidities. The CHA2DS2-VASc-score was calculated at first visit(for controls)or baseline and at 12-months. Patients on warfarin prior to BS and with valvular-AF were excluded.

Results

From 4,226 bariatric patients, 2.1%(N=90) had AF. Of which 57.8%(N=52) male, 46.6%(N=42) had LSG with a baseline BMI39.7±6.4kg/m2. Controls were 61%(N=58)males and BMI of 38.7±5kg/m2. At follow-up, stroke improved significantly in relation to the controls; 21.1%vs.31.1%(p=<0.001)(Table1) with a relative risk reduction(RRR) of 71%. Baseline CHA2DS-VaSc2-score was not significant for stroke(p=0.07) or systemic embolism/TIA risk(p=0.06)(Table2). The 12-months analysis revealed a reduction of 2-points of the score, in relation to the control(2.8 points vs. 4.8 points; p<0.001). Similarly, 52% RRR for the predicted risk of stroke (3.3% vs. 6.9%; p<0.001) and 53% of systemic embolism/TIA (4.5% vs. 9.7%; p<0.001)(Table3).

Conclusions

Our results showed a risk reduction of developing a stroke in 1-year of 71% in bariatric patients in relation to non-bariatric, with over 50% reduction in the CHA2DS2-VASc-score predicted. Consequently, a reduction of a lethal complication of obesity.