Atrial Fibrillation and the Risk of Ischemic Stroke

Chao, Tze Fan; Liu, Chia Jen; Chen, Su Jung; Wang, Kang Ling; Lin, Yenn Jiang; Chang, Shih Lin; Lo, Li Wei; Hu, Yu Feng; Tuan, Ta Chuan; Wu, Tsu Juey; Chen, Tzeng Ji; Tsao, Hsuan Ming; Chen, Shih Ann

doi:10.1161/strokeaha.112.667865

Cited by 72 publications

(30 citation statements)

References 25 publications

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“…Occurrence of lone AF probably does not increase the risk of stroke in younger people. Young patients with documented AF but without known vascular risk factors had the same rates of stroke as healthy controls [20]. These data suggest that thromboembolic risk may be triggered by something more than just the arrhythmia.…”

Section: Introductionmentioning

confidence: 65%

Mechanisms of cardioembolic stroke revisited. Atrial cardiopathy

Mączyńska

Kurkowska‐Jastrzębska

Dąbrowski

2018

Kardiol Pol

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Section: Introductionmentioning

confidence: 65%

Mechanisms of cardioembolic stroke revisited. Atrial cardiopathy

Mączyńska

Kurkowska‐Jastrzębska

Dąbrowski

2018

Kardiol Pol

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“…More recently, a nationwide cohort study in Taiwan further demonstrated that AF males with a CHA 2 DS 2 -VASc score of 0 have a truly low-risk for stroke, which was similar to that of non-AF patients (1.6 versus 1.6 %, p-value: 0.92) during a follow-up of 57.4 ± 35.7 months. 24 In the same study, the annual stroke rate was around 0.92 % for AF females with a CHA 2 DS 2 -VASc score of 1 (only 1.45 % per year for dabigatran 150 mg). 25 It should be emphasised that the bleeding risk in RE-LY is under ideal, clinical trial circumstances, and the bleeding rate could probably be even higher in real life.…”

Section: The Usefulness Of the Cha 2 Ds 2 -Vasc Score In Identifying mentioning

confidence: 86%

“…4 ± 35.7 months. 24 In the same study, the annual stroke rate was around 0.92 % for AF females with a CHA 2 DS 2 -VASc score of 1 (only due to gender), 24 which was lower than that of life-threatening bleeding of dabigatran use in the Randomized Evaluation of Long Term Anticoagulant Therapy (RE-LY) study (1.22 % per year for dabigatran 110 milligrams [mg]; …”

mentioning

confidence: 98%

Stroke in Atrial Fibrillation – Long-term Follow-up of Cardiovascular Events

Chao

Chiang

Chen

2013

Arrhythmia &Amp; Electrophysiology Review

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Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice, accounting for approximately one-third of hospitalisations for cardiac rhythm disturbances.1 Between 1980 and 2000, the age-adjusted incidence of AF significantly increased from 3.04 to 3.68 per 1,000 person-years in the US. 2 The prevalence of AF was lower among African Americans than among Caucasians, 3 and it also seemed to be lower in the Asian population. 4,5 In a nationwide cohort of 702,502 participants in Taiwan, the AF incidence was around 1.5 per 1,000 person-years. 6 Since a considerable number of AF patients was paroxysmal in nature, the incidence and prevalence of AF could be significantly underestimated.Systemic thromboembolism is the most severe complication of AF. It accounts for about 15-20 % of ischaemic strokes.7 AF-related strokes were associated with a poor prognosis as more than 50 % of the survivors remain with a severe deficit, and recurrence may be as high as 12 % per year. 8 The risk of AF-related stroke was higher in Caucasian populations than in Asians populations (see Figure 1). 4,[9][10][11][12][13][14][15] AF could in fact drive a prothrombotic or hypercoagulable state, by virtue of its fulfilment of Virchow's triad for thrombogenesis (blood stasis, endocardial dysfunction/damage, and abnormal haemostasis). The most important point in determining the strategy of stroke prevention for AF is how to estimate the thromboembolic (TE) risk accurately. The CHADS 2 score is the most commonly used scheme in stroke risk stratifications for AF patients, 17 despite the fact that it classifies a large proportion of patients as being at 'intermediate risk', and several important TE risk factors were omitted in the scoring system. 18 Recently, a newly developed scoring system, CHA 2 DS 2 -VASc score, which extends the CHADS 2 scheme by considering additional stroke risk factors (vascular diseases and female gender) was recommended to be used to guide the antithrombotic therapies for AF patients. 19,20 The CHA 2 DS 2 -VASc score is most useful in identifying truly low-risk patients, and no antithrombotic therapy is necessary for patients with a CHA 2 DS 2 -VASc score of 0. [21][22][23] In the study performed by Taillandier et al., which enrolled a total of 616 AF patients with a CHA 2 DS 2 -VASc score of 0, an OAC was prescribed on an individual basis in 273 patients (44 %), antiplatelet therapy alone in 145 patients (24 %), and no antithrombotic therapy in 198 patients (32 %).22 During a follow-up of 876 ± 1,135 days, 38 patients experienced adverse events (10 stroke/thromboembolism, 19 major bleeding, 17 deaths). Prescription of OACs and/or antiplatelet therapy was not associated with an improved prognosis for stroke/thromboembolism (relative risk: 0.99, 95 % confidence interval: 0.25-3.99, p-value: 0.99), nor improved survival or net clinical benefit (combination of stroke/ thromboembolism, bleeding and death). More recently, a nationwide cohort study in Taiwan further demonstrated that AF males with a CHA 2 ...

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“…Of note, current European Society of Cardiology (ESC) guidelines 27 recommend considering women with AF without any other risk factor for stroke as having a global risk score of 0, so they should not assume any antithrombotic therapy. However, recently, a study by Chao et al 28 questioned this assumption: the authors enrolled 509 males (CHA 2 DS 2 -VASc score 0) and 320 females (CHA 2 DS 2 -VASc score 1) with AF, who were not receiving, according to guidelines, any antithrombotic therapy and matched control subjects without AF and any comorbidity from CHA 2 DS 2 -VASc (mean age 45 years). During the followup, 128 patients (1.4%) experienced ischemic stroke but, while the event rate did not differ between groups with and without AF for male patients (1.6% versus 1.6%; P=0.920), AF resulted in a significant risk factor for ischemic stroke among females (hazard ratio, 7.77), with event rates of 4.4% and 0.7% for female patients with and without AF (P,0.001).…”

Section: Common Risk Factors For Strokementioning

confidence: 99%

Atrial fibrillation and its influence on stroke risk

Prisco¹,

Cenci²,

Silvestri³

et al. 2015

RRCC

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Atrial fibrillation (AF) is the most common cardiac arrhythmia in the clinical setting. AF increases both the risk and severity of stroke, and is associated with substantial morbidity and mortality. Decisions regarding appropriate stroke prevention in AF patients are crucial and require individual assessment of both thromboembolic and bleeding risk. This review will provide an overview of recommended risk assessment tools and discuss other possible risk factors which could improve risk stratification in AF patients.

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Atrial Fibrillation and the Risk of Ischemic Stroke

Cited by 72 publications

References 25 publications

Mechanisms of cardioembolic stroke revisited. Atrial cardiopathy

Mechanisms of cardioembolic stroke revisited. Atrial cardiopathy

Stroke in Atrial Fibrillation – Long-term Follow-up of Cardiovascular Events

Atrial fibrillation and its influence on stroke risk

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