Atrial fibrillation and stroke

Choi, Sylvia E; Sagris, Dimitrios; Hill, Andrew; Lip, Gregory Y.H.; Abdul-Rahim, Azmil H

doi:10.1080/14779072.2023.2160319

Cited by 33 publications

(24 citation statements)

References 279 publications

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“…Atrial fibrillation (AF) is a common arrhythmia in the elderly population, affecting up to 12% of people aged 80 years and older 1 and can raise the risk of stroke by five-fold. 2 AF and related stroke in the elderly seriously affect their quality of life and greatly increase the burden on the healthcare industry.…”

Section: Introductionmentioning

confidence: 99%

Effects of Anticoagulant Therapy and Frailty in the Elderly Patients with Atrial Fibrillation

Ding,

Sun,

Zhang

et al. 2024

CIA

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Objective This study explored whether anticoagulation is safe for frail and non-frail elderly patients who have nonvalvular atrial fibrillation (NVAF). Methods At hospital discharge, the anticoagulant regimen and frailty status were recorded for 361 elderly patients (aged ≥75 y) with NVAF. The patients were followed for 12 months. The endpoints included occurrence of thrombosis; bleeding; all-cause death; and cardiovascular events. Results At hospital discharge, frailty affected 50.42% of the population and the anticoagulation rate was 44.04%. At discharge, age (OR 0.948, P = 0.006), paroxysmal NVAF (OR 0.384, P < 0.001), and bleeding history (OR 0.396, P = 0.001) were associated with a decrease in rate of receiving anticoagulation, while thrombotic events during hospitalization (OR 2.281, P = 0.021) were associated with an increase. Relative to non-frail patients, those with frailty showed a higher rate of ischemic stroke (5.33% cf. 3.01%), bleeding ( P = 0.006) events, and all-cause mortality ( P = 0.001). Relative to the group without anticoagulation, in those with anticoagulation the rate of thrombotic events was lower (6.99 cf. 10.98%) and bleeding events were higher (20.98 cf. 12.72%), but the risk of major bleeding was comparable. Conclusion In the elderly patients with NVAF, the decision toward anticoagulation therapy at hospital discharge was influenced by age, bleeding history, paroxysmal atrial fibrillation diagnosis, and absence of thrombosis. Frail patients were at greater risk of bleeding and all-cause mortality. Anticoagulation tended to reduce the risk of thrombotic events.

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Section: Introductionmentioning

confidence: 99%

Effects of Anticoagulant Therapy and Frailty in the Elderly Patients with Atrial Fibrillation

Ding,

Sun,

Zhang

et al. 2024

CIA

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“…38 Thus, primary as well as secondary prevention of the thromboembolism and ischemic stroke risk with anticoagulation is one of the cornerstones of AF management in suitable AF patients. 39 Due to the better clinical efficacy profile (systemic embolism and the stroke) as well as the clinical safety (major bleeding and intracranial Our meta-analysis revealed that obese patients with AF who received DOACs, as compared with VKAs, had significantly lower occurrences of composite events as well as individual events: stroke (ischemic as well as hemorrhagic) and systemic embolic events, in overall. The DOACs also significantly lowered major bleeding rates, including GI bleeding, ICH, and all-cause mortality in this patient cohort.…”

Section: Discussionmentioning

confidence: 99%

“…Obesity is a well‐established risk factor for AF, which itself carries a high risk of major life‐threatening thromboembolism and ischemic stroke 38 . Thus, primary as well as secondary prevention of the thromboembolism and ischemic stroke risk with anticoagulation is one of the cornerstones of AF management in suitable AF patients 39 . Due to the better clinical efficacy profile (systemic embolism and the stroke) as well as the clinical safety (major bleeding and intracranial hemorrhage), thus higher mortality benefit, of DOACs over the warfarin, DOACs are recommended over warfarin for the anticoagulation in AF patients in the 2023 ACC/AHA/ACCP/HRS guideline.…”

Section: Discussionmentioning

confidence: 99%

“… 38 Thus, primary as well as secondary prevention of the thromboembolism and ischemic stroke risk with anticoagulation is one of the cornerstones of AF management in suitable AF patients. 39 Due to the better clinical efficacy profile (systemic embolism and the stroke) as well as the clinical safety (major bleeding and intracranial hemorrhage), thus higher mortality benefit, of DOACs over the warfarin, DOACs are recommended over warfarin for the anticoagulation in AF patients in the 2023 ACC/AHA/ACCP/HRS guideline. However, there was little clinical evidence to support this clinical safety and efficacy superiority profiles of DOACs over warfarin among obese patients with AF.…”

Section: Discussionmentioning

confidence: 99%

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Safety and efficacy of direct oral anticoagulants in comparison to warfarin in obese patients with atrial fibrillation: A systematic review and meta‐analysis

Adelkhanova,

Oli,

Shrestha

et al. 2024

Health Science Reports

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Background and AimObesity affects nearly 650 million adults worldwide, and the prevalence is steadily rising. This condition has significant adverse effects on cardiovascular health, increasing the risk of hypertension, coronary artery disease, heart failure, and atrial fibrillation (AF). While anticoagulation for obese patients with AF is a well‐established therapy for the prevention of thromboembolism, the safety and efficacy of different anticoagulants in this specific population are not well explored. This meta‐analysis aimed to compare direct oral anticoagulants (DOAC) to vitamin K antagonists in obese populations with AF.MethodsThe PRISMA guidelines were followed for this meta‐analysis, registered in PROSPERO (CRD42023392711). PubMed, PubMed Central, Embase, Cochrane Library, and Scopus databases were searched for relevant articles from inception through January 2023. Two independent authors screened titles and abstracts, followed by a full‐text review in Covidence. Data were extracted in Microsoft Excel and analyzed using RevMan v5.4 using odds ratio as an effect measure.ResultsTwo thousand two hundred fifty‐nine studies were identified from the database search, and 18 were included in the analysis. There were statistically significant reductions in the odds of ischemic and hemorrhagic stroke in the DOAC group compared with the VKA group (OR 0.70, CI 0.66–0.75) and (OR 0.47, CI 0.35–0.62), respectively. In addition, the DOAC group exhibited lower odds of systemic embolism (OR 0.67, CI 0.54–0.83), major bleeding (OR 0.62, CI 0.54–0.72), and composite outcome (OR 0.72, CI 0.63–0.81).ConclusionBased on the findings from this meta‐analysis, DOACs demonstrate superior safety and efficacy in obese patients with AF compared with VKAs. These results may have significant implications for guiding anticoagulation strategies in this patient population.

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“…Stroke remains among the leading causes of mortality and long-term disability globally [ 1 , 2 ]. Atrial fibrillation (AF), in turn, is the most common sustained arrhythmia and one of the strongest risk factors and causal mechanisms for ischemic stroke (IS) [ 3 , 4 , 5 , 6 , 7 ]. Cardioembolic causes account for 20–25% of all IS patients, with known AF being by far the most frequently documented source for cardioembolism [ 4 , 8 , 9 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Stroke in Patients with Atrial Fibrillation: Epidemiology, Screening, and Prognosis

Suomalainen,

Martinez-Majander,

Broman

et al. 2023

JCM

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Atrial fibrillation (AF) is the most common sustained arrythmia and one of the strongest risk factors and causal mechanisms of ischemic stroke (IS). Acute IS due to AF tends to be more severe than with other etiology of IS and patients with treated AF have reported to experience worse outcomes after endovascular treatment compared with patients without AF. As cardioembolism accounts for more than a fifth of ISs and the risk of future stroke can be mitigated with effective anticoagulation, which has been shown to be effective and safe in patients with paroxysmal or sustained AF, the screening of patients with cryptogenic IS (CIS) for AF is paramount. Embolic stroke of undetermined source (ESUS) is a subtype of CIS with a high likelihood of cardioembolism. The European Stroke Organization and European Society of Cardiology guidelines recommend at least 72 h of screening when AF is suspected. The longer the screening and the earlier the time point after acute IS, the more likely the AF paroxysm is found. Several methods are available for short-term screening of AF, including in-hospital monitoring and wearable electrocardiogram recorders for home monitoring. Implantable loop monitors provide an effective long-term method to screen patients with high risk of AF after IS and artificial intelligence and convolutional neural networks may enhance the efficacy of AF screening in the future. Direct oral anticoagulants (DOACs) are preferred over vitamin K antagonists in both primary and secondary prevention of IS in AF patients. Recent data from the randomized controlled trials (RCT) also suggest that early initiation of DOAC treatment after acute IS is safe compared to later initiation. Anticoagulation treatment may still predispose for intracranial bleeding, particularly among patients with prior cerebrovascular events. Left atrial appendix closure offers an optional treatment choice for patients with prior intracranial hemorrhage and may offer an alternative to oral anticoagulation even for patients with IS, but these indications await validation in ongoing RCTs. There are still controversies related to the association of found AF paroxysms in CIS patients with prolonged screening, pertaining to the optimal duration of screening and screening strategies with prolonged monitoring techniques in patients with ESUS. In this review, we summarize the current knowledge of epidemiology, screening, and prognosis in AF patients with stroke.

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Atrial fibrillation and stroke

Cited by 33 publications

References 279 publications

Effects of Anticoagulant Therapy and Frailty in the Elderly Patients with Atrial Fibrillation

Effects of Anticoagulant Therapy and Frailty in the Elderly Patients with Atrial Fibrillation

Safety and efficacy of direct oral anticoagulants in comparison to warfarin in obese patients with atrial fibrillation: A systematic review and meta‐analysis

Stroke in Patients with Atrial Fibrillation: Epidemiology, Screening, and Prognosis

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