Association of improved outcome in acute ischaemic stroke patients with atrial fibrillation who receive early antithrombotic therapy: analysis from <scp>VISTA</scp>

Abdul-Rahim, Azmil H; Fulton, Rachael L.; Frank, Benedikt; Tatlısumak, Turgut; Paciaroni, Maurizio; Caso, Valeria; Diener, Hans‐Christoph; Lees, Kennedy R.

doi:10.1111/ene.12577

Cited by 73 publications

(64 citation statements)

References 29 publications

(28 reference statements)

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“…Patients who received LMWH were likely patients with more severe stroke who were more likely to have dysphagia and perhaps to be at inherently greater risk of adverse outcomes. It also appears likely that LMWH may have been initiated earlier than NOACs, at a time when there was an inherently much higher rate of ischemic and hemorrhagic events, regardless of treatment allocation 30. We think that considering the similar pharmacokinetics of NOACs and LMWH, it is not recommended to start with LMWH before NOACs.…”

Section: Discussionmentioning

confidence: 99%

Early Recurrence and Major Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation Treated With Non–Vitamin‐K Oral Anticoagulants (RAF‐NOACs) Study

Paciaroni

Agnelli

Falocci

et al. 2017

JAHA

102

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BackgroundThe optimal timing to administer non–vitamin K oral anticoagulants (NOACs) in patients with acute ischemic stroke and atrial fibrillation is unclear. This prospective observational multicenter study evaluated the rates of early recurrence and major bleeding (within 90 days) and their timing in patients with acute ischemic stroke and atrial fibrillation who received NOACs for secondary prevention.Methods and ResultsRecurrence was defined as the composite of ischemic stroke, transient ischemic attack, and symptomatic systemic embolism, and major bleeding was defined as symptomatic cerebral and major extracranial bleeding. For the analysis, 1127 patients were eligible: 381 (33.8%) were treated with dabigatran, 366 (32.5%) with rivaroxaban, and 380 (33.7%) with apixaban. Patients who received dabigatran were younger and had lower admission National Institutes of Health Stroke Scale score and less commonly had a CHA 2 DS 2‐VASc score >4 and less reduced renal function. Thirty‐two patients (2.8%) had early recurrence, and 27 (2.4%) had major bleeding. The rates of early recurrence and major bleeding were, respectively, 1.8% and 0.5% in patients receiving dabigatran, 1.6% and 2.5% in those receiving rivaroxaban, and 4.0% and 2.9% in those receiving apixaban. Patients who initiated NOACs within 2 days after acute stroke had a composite rate of recurrence and major bleeding of 12.4%; composite rates were 2.1% for those who initiated NOACs between 3 and 14 days and 9.1% for those who initiated >14 days after acute stroke.ConclusionsIn patients with acute ischemic stroke and atrial fibrillation, treatment with NOACs was associated with a combined 5% rate of ischemic embolic recurrence and severe bleeding within 90 days.

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Section: Discussionmentioning

confidence: 99%

Early Recurrence and Major Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation Treated With Non–Vitamin‐K Oral Anticoagulants (RAF‐NOACs) Study

Paciaroni

Agnelli

Falocci

et al. 2017

JAHA

102

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“…5 This international prospective multicenter study in patients with acute stroke and AF evaluated at 90 days from the acute event (1) the risk of recurrent ischemic embolic event and severe bleeding (both intra and extracranial); (2) the risk factors associated with ischemic stroke recurrence, systemic embolism, and symptomatic cerebral bleeding, as well as severe extracerebral hemorrhage; and (3) the risk of recurrence and bleeding associated with anticoagulant therapy and its timing.…”

mentioning

confidence: 99%

Early Recurrence and Cerebral Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation

Paciaroni

Agnelli

Falocci

et al. 2015

Stroke

242

185

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Background and Purpose— The best time for administering anticoagulation therapy in acute cardioembolic stroke remains unclear. This prospective cohort study of patients with acute stroke and atrial fibrillation, evaluated (1) the risk of recurrent ischemic event and severe bleeding; (2) the risk factors for recurrence and bleeding; and (3) the risks of recurrence and bleeding associated with anticoagulant therapy and its starting time after the acute stroke. Methods— The primary outcome of this multicenter study was the composite of stroke, transient ischemic attack, symptomatic systemic embolism, symptomatic cerebral bleeding and major extracranial bleeding within 90 days from acute stroke. Results— Of the 1029 patients enrolled, 123 had 128 events (12.6%): 77 (7.6%) ischemic stroke or transient ischemic attack or systemic embolism, 37 (3.6%) symptomatic cerebral bleeding, and 14 (1.4%) major extracranial bleeding. At 90 days, 50% of the patients were either deceased or disabled (modified Rankin score ≥3), and 10.9% were deceased. High CHA 2 DS 2 -VASc score, high National Institutes of Health Stroke Scale, large ischemic lesion and type of anticoagulant were predictive factors for primary study outcome. At adjusted Cox regression analysis, initiating anticoagulants 4 to 14 days from stroke onset was associated with a significant reduction in primary study outcome, compared with initiating treatment before 4 or after 14 days: hazard ratio 0.53 (95% confidence interval 0.30–0.93). About 7% of the patients treated with oral anticoagulants alone had an outcome event compared with 16.8% and 12.3% of the patients treated with low molecular weight heparins alone or followed by oral anticoagulants, respectively ( P =0.003). Conclusions— Acute stroke in atrial fibrillation patients is associated with high rates of ischemic recurrence and major bleeding at 90 days. This study has observed that high CHA 2 DS 2 -VASc score, high National Institutes of Health Stroke Scale, large ischemic lesions, and type of anticoagulant administered each independently led to a greater risk of recurrence and bleedings. Also, data showed that the best time for initiating anticoagulation treatment for secondary stroke prevention is 4 to 14 days from stroke onset. Moreover, patients treated with oral anticoagulants alone had better outcomes compared with patients treated with low molecular weight heparins alone or before oral anticoagulants.

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“…Однако при от-дельной оценке данной группы пациентов бы-ло выявлено, что повторные НМК у этой кате-гории за 10 лет наблюдения были отмечены у 28,6%. Перенесенный инсульт в анамнезе явля-ется независимым фактором риска повторных НМК [1][2][3]19] Так, по данным работ, посвя-щенных краткосрочному прогнозу больных с ФП, перенесших острый инсульт, выявлено, что частота повторных инсультов достигает 7,6-10% в течение 90 дней [6,[20][21]. Среди наших 49 пациентов, перенесших инсульты до момента включения в исследование, у 20 (40,8%) инсульт произошел в течение послед-него года, что делает этих пациентов наиболее уязвимыми в отношении повторных мозговых катастроф.…”

Section: Discussionunclassified

THE EFFICACY OF LONG-TERM WARFARIN THERAPY: THE IMPACT ON THE INCIDENCE OF ISCHEMIC CEREBROVASCULAR DISORDERS AND CLINICAL PREDICTORS OF DEVELOPING SUCH DISORDERS. (Results of a prospective 10-year follow-up study)

et al. 2017

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Association of improved outcome in acute ischaemic stroke patients with atrial fibrillation who receive early antithrombotic therapy: analysis from VISTA

Cited by 73 publications

References 29 publications

Early Recurrence and Major Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation Treated With Non–Vitamin‐K Oral Anticoagulants (RAF‐NOACs) Study

Early Recurrence and Major Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation Treated With Non–Vitamin‐K Oral Anticoagulants (RAF‐NOACs) Study

Early Recurrence and Cerebral Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation

THE EFFICACY OF LONG-TERM WARFARIN THERAPY: THE IMPACT ON THE INCIDENCE OF ISCHEMIC CEREBROVASCULAR DISORDERS AND CLINICAL PREDICTORS OF DEVELOPING SUCH DISORDERS. (Results of a prospective 10-year follow-up study)

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