Anticoagulant therapy in recurrent cerebral embolism: a retrospective study in non-valvular atrial fibrillation

Yamanouchi, Hiroshi; Nishimura, Hiroshi; Ohkawa, Yasunobu; Sakurai, Yosuke; Kuzuhara, Shigeki; Kuramoto, Kizuku; Shimada, Hiroyuki; Toyokura, Y

doi:10.1007/bf00314482

Cited by 12 publications

(2 citation statements)

References 32 publications

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“…The recurrence rate of embolic stroke is high not only in AF associated with rheumatic heart disease 23 -26 but also in NVAF. - 27 Our study shows that half of the fatal massive infarctions associated with NVAF were first strokes and suggests that primary prophylaxis, 28 -29 as well as secondary prevention, 30 should be considered to prevent fatal massive infarction in elderly NVAF patients.…”

Section: Discussionmentioning

confidence: 83%

Nonvalvular atrial fibrillation as a cause of fatal massive cerebral infarction in the elderly.

Yamanouchi

Tomonaga

Shimada

et al. 1989

Stroke

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By studying 3,408 consecutive autopsied elderly patients, we found that two thirds of the 132 massive cerebral infarctions (86) were embolic, of cardiac origin. Embolic infarction associated with nonvalvular atrial fibrillation was seen in 48 cases (36%), half due to the first stroke. Embolic infarction associated with heart diseases other than nonvalvular atrial fibrillation was seen in 23 cases (17%), and that from nonbacterial thrombotic endocarditis was seen in 15 cases (11%). Thrombotic infarction or infarction of nonembolic cardiac origin was found in only 39 cases (30%). Of 56 patients with fatal massive cerebral infarction who died <2 weeks after their stroke, 25 (45%) had embolic strokes associated with nonvalvular atrial fibrillation. Our study shows that nonvalvular atrial fibrillation is a very important cause of fatal massive cerebral infarction in the elderly. (Stroke 1989;20:1653-1656

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Section: Discussionmentioning

confidence: 83%

Nonvalvular atrial fibrillation as a cause of fatal massive cerebral infarction in the elderly.

Yamanouchi

Tomonaga

Shimada

et al. 1989

Stroke

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“…Therefore, we extracted data from a total of 26 studies, reporting outcomes on 23,054 patients. 15–40 Figure 1 shows the process of study selection. Table 1 presents the baseline characteristics of included studies.…”

Section: Resultsmentioning

confidence: 99%

The impact of atrial fibrillation type on the risks of thromboembolic recurrence, mortality and major haemorrhage in patients with previous stroke: A systematic review and meta-analysis of observational studies

Mentel

Quinn

Cameron

et al. 2020

European Stroke Journal

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Introduction There is conflicting evidence on the impact of atrial fibrillation (AF) type, i.e. non-paroxysmal AF or paroxysmal AF, on thromboembolic recurrence. The consensus of risk equivalence is greatly based on historical evidence, focussing on initial stroke risks. We conducted a systematic review and meta-analysis to describe the impact of AF type on the risk of thromboembolic recurrence, mortality and major haemorrhage in patients with previous stroke. Methods We systematically searched four multidisciplinary databases from inception to December 2018. We selected observational studies investigating clinical outcomes in patients with ischaemic stroke and AF, stratified by AF type. We assessed all included studies for risk of bias using the ‘Risk of Bias In Non-randomised Studies – of Exposures’ tool. The Comprehensive Meta-Analysis Software was used to calculate odds ratios from crude event rates. Results After reviewing 14,127 citations, we selected 108 studies for full-text screening. We extracted data from a total of 26 studies, reporting outcomes on 23,054 patients. Overall, risk of bias was moderate. The annual incidence rates of thromboembolism in patients with non-paroxysmal AF and paroxysmal AF were 7.1% (95% confidence interval: 4.2–11.7) and 5.2% (95% confidence interval: 3.2–8.2), respectively. The odds ratio for thromboembolism in patients with non-paroxysmal AF versus paroxysmal AF was 1.47 (95% confidence interval: 1.08–1.99, p = 0.013). The annual mortality rates in patients with non-paroxysmal AF and paroxysmal AF were 20.0% (95% confidence interval: 13.2–28.0) and 10.1% (95% confidence interval: 5.4–17.3), respectively, and odds ratio was 1.90 (95% confidence interval: 1.43–2.52, p < 0.001). There was no difference in rates of major haemorrhage, odds ratio = 1.01 (95% confidence interval: 0.61–1.69, p = 0.966). Conclusion In patients with prior stroke, non-paroxysmal AF is associated with significantly higher risk of thromboembolic recurrence and mortality than paroxysmal AF. Although current guidelines make no distinction between non-paroxysmal AF and paroxysmal AF for secondary stroke prevention, future guidance and risk stratification tools may need to consider this differential risk (PROSPERO ID: CRD42019118531).

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Durchblutungsstörungen und Blutungen im Zentralnervensystem (ZNS)

Jörg¹

1989

Spezielle Neurologische Therapie

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Anticoagulant therapy in recurrent cerebral embolism: a retrospective study in non-valvular atrial fibrillation

Cited by 12 publications

References 32 publications

Nonvalvular atrial fibrillation as a cause of fatal massive cerebral infarction in the elderly.

Nonvalvular atrial fibrillation as a cause of fatal massive cerebral infarction in the elderly.

The impact of atrial fibrillation type on the risks of thromboembolic recurrence, mortality and major haemorrhage in patients with previous stroke: A systematic review and meta-analysis of observational studies

Durchblutungsstörungen und Blutungen im Zentralnervensystem (ZNS)

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