Antithrombotic treatment for secondary prevention of stroke and other thromboembolic events in patients with stroke or transient ischemic attack and non-valvular atrial fibrillation: A European Stroke Organisation guideline

Klijn, Catharina J.M.; Paciaroni, Maurizio; Berge, Eivind; Korompoki, Eleni; Kõrv, Janika; Lal, Avtar; Putaala, Jukka; Werring, David J.

doi:10.1177/2396987319841187

Cited by 144 publications

(143 citation statements)

References 96 publications

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“…In RCT subanalyses that compared the efficacy and safety of NOACs against VKA, it was not shown that the use of NOACs has a different effect in the elderly population compared to younger people (17)(18)(19). The ESO Guideline gives preference to NOACs over VKA in the elderly population, although there is currently no data on whether there are differences between older and younger patients with previous IS and AF (22).…”

Section: The Noacs In Specific Groups Of Patients With Previous Is Anmentioning

confidence: 99%

“…The introduction of OAC in these patients should consider the degree of cognitive decline, ability to understand, quality of life and life expectancy, the possibility of poor therapeutic adherence, and higher risks of hemorrhagic complications. The ESO Guideline gives preference to NOACs over VKA in the secondary prevention of IS in patients with AF and cognitive deficits (22).…”

Section: The Noacs In Specific Groups Of Patients With Previous Is Anmentioning

confidence: 99%

“…There are currently no studies comparing the use of NOACs with VKA in patients with previous IS who have mild or moderate renal insufficiency. In the secondary prevention of IS, the use of NOACs is recommended in these patients in adjusted doses as well as in primary prevention (22).…”

Section: The Noacs In Specific Groups Of Patients With Previous Is Anmentioning

confidence: 99%

“…However, it is necessary to wait for ongoing studies to provide solid recommendations on this issue. Theoretically, NOACs may have an advantage over VKA in patients with SVD and previous AF (22).…”

Section: The Noacs In Patients With Svdmentioning

confidence: 99%

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Non-vitamin K oral anticoagulants (NOACs) in patients with stroke and atrial fibrillation

Jovanović¹

2020

Arhiv za farmaciju

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Patients with atrial fibrillation who had a previous transient ischemic attack or ischemic stroke had a significantly high risk of stroke recurrence and the introduction of oral anticoagulants should be mandatory. However, the long-term use of oral anticoagulants increases the risk of developing all types of intracranial hemorrhages. The advantages of non-vitamin K oral anticoagulants (NOACs) compared to warfarin are that they have a significantly lower risk for hemorrhagic stroke. They are preferred in elderly patients, those with small vessel disease, or those with previous intracerebral hemorrhage. The time of NOACs introduction after an ischemic stroke depends on its severity and the rule "1-3-6-12" days should be applied. The reintroduction of NOACs in patients with atrial fibrillation and previous intracerebral hemorrhage depends on its etiology and should be after about 4-8 weeks if the cardioembolic risk is high and the risk for intracranial hemorrhage small.

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Section: The Noacs In Specific Groups Of Patients With Previous Is Anmentioning

confidence: 99%

Section: The Noacs In Specific Groups Of Patients With Previous Is Anmentioning

confidence: 99%

Section: The Noacs In Specific Groups Of Patients With Previous Is Anmentioning

confidence: 99%

Section: The Noacs In Patients With Svdmentioning

confidence: 99%

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Non-vitamin K oral anticoagulants (NOACs) in patients with stroke and atrial fibrillation

Jovanović¹

2020

Arhiv za farmaciju

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“…Thus, current guidelines emphasize prolonged cardiac rhythm monitoring for AF in cryptogenic stroke [14][15][16][17]. However, prolonged cardiac rhythm monitoring (a minimum of 24 hours) for AF are not usually used as recommended in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Influencing factors of AF detection in cryptogenic stroke: A survey among neurologists in China

Bi¹,

He²,

Lu³

et al. 2019

Preprint

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Background and Purpose-Atrial fibrillation (AF) detection is a cornerstone of cardioembolic stroke prevention and is especially recommended in patients initially diagnosed cryptogenic stroke, but few data exist about the extent of AF detection. This study aimed to investigate influencing factors of AF detection for cryptogenic stroke patients from neurologists' perspective. Methods-A questionnaire survey was conducted from October 2016 to March 2018 and included neurologists from 42 hospitals in China. Respondents' demographic characteristics, AF-related knowledge and education, attitude to AF detection and daily AF detection practice were surveyed. Pearson chi-square tests and logistic regression were used to identify neurologists characteristics independently associated with AF detection. Results-611 neurologists were surveyed in this study and 53.0% reported always detecting AF among cryptogenic stroke patients. The main obstacles of AF detection were insufficient knowledge, high expense and inactive attitude. Those who received continuing medical education (training program) about AF detection (OR=2.25, CI[1.57, 3.23], p<0.001), who had positive attitude (OR=3.25,CI [2.24, 4.71], p<0.001) and who acquired graduate degree (OR=2.48, CI[1.21, 5.07], p=0.013) were more likely to detect AF in cryptogenic stroke patients. Neurologists who had worked in neurology over 20 years (OR=3.59, CI[1.61, 8.05], p=0.002), and who received continuing medical education (OR=1.82, CI[1.21, 2.58], p=0.001) were more likely to have an positive attitude to AF detection.Conclusions-Our survey suggested inadequate AF detection among neurologists, and continuing medical education was associated with neurologists' attitude and AF detection behavior. More continuing medical education is required to increase the effective detection of AF and improve the quality of clinical practice.

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Antithrombotic treatment after stroke due to intracerebral haemorrhage

Cochrane

Chen

Stephen

et al. 2023

Cochrane Database of Systematic Reviews

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Background This is an update of the Cochrane Review last published in 2017. Survivors of stroke due to intracerebral haemorrhage (ICH) are at risk of major adverse cardiovascular events (MACE). Antithrombotic (antiplatelet or anticoagulant) treatments may lower the risk of ischaemic MACE after ICH, but they may increase the risk of bleeding. Objectives To determine the overall effectiveness and safety of antithrombotic drugs on MACE and its components for people with ICH. Search methods We searched the Cochrane Stroke Group Trials Register (5 October 2021). We also searched the Cochrane Central Register of Controlled Trials (CENTRAL: the Cochrane Library 2021, Issue 10), MEDLINE Ovid (from 1948 to October 2021) and Embase Ovid (from 1980 to October 2021). The online registries of clinical trials searched were the US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov (clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (5 October 2021). We screened the reference lists of included randomised controlled trials (RCTs) for additional, potentially relevant RCTs. Selection criteria We selected RCTs in which participants with ICH of any age were allocated to a class of antithrombotic treatment as intervention or comparator. Data collection and analysis In accordance with standard methodological procedures recommended by Cochrane, two review authors assessed each selected RCT for its risk of bias and extracted data independently. The primary outcome was a composite of MACE, and secondary outcomes included death, individual components of the MACE composite, ICH growth, functional status and cognitive status. We estimated effects using the frequency of outcomes that occurred during the entire duration of follow‐up and calculated a risk ratio (RR) for each RCT. We grouped RCTs separately for analysis according to 1) the class(es) of antithrombotic treatment used for the intervention and comparator, and 2) the duration of antithrombotic treatment use (short term versus long term). We pooled the intention‐to‐treat populations of RCTs using a fixed‐effect model for meta‐analysis, but used a random‐effects model if RCTs differed substantially in their design or there was considerable heterogeneity (I 2 ≥ 75%) in their results. We applied GRADE to assess the certainty of the evidence. Main results We identified seven new completed RCTs for this update, resulting in the inclusion of a total of nine RCTs based in secondary care, comprising 1491 participants (average age ranged from 61 to 79 years and the proportion of men ranged from 44% to 67%). The proportion of included RCTs at low risk of bias, by category was: random sequence generation (67%), allocation concealment (67%), performance (22%), detection (78%), attrition (89%), and reporting...

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Antithrombotic treatment for secondary prevention of stroke and other thromboembolic events in patients with stroke or transient ischemic attack and non-valvular atrial fibrillation: A European Stroke Organisation guideline

Cited by 144 publications

References 96 publications

Non-vitamin K oral anticoagulants (NOACs) in patients with stroke and atrial fibrillation

Non-vitamin K oral anticoagulants (NOACs) in patients with stroke and atrial fibrillation

Influencing factors of AF detection in cryptogenic stroke: A survey among neurologists in China

Antithrombotic treatment after stroke due to intracerebral haemorrhage

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