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

Abstract

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.

Direct oral anticoagulants versus vitamin K antagonists after recent ischemic stroke in patients with atrial fibrillation

“…ANN NEUROL 2019;85:823-834 O ral anticoagulation is effective in the prevention of ischemic stroke and systemic embolism in patients with atrial fibrillation (AF). [18][19][20][21][22][23][24][25] Thus, we compared the clinical benefit of DOAC and VKA in patients having AF with a recent ischemic stroke or transient ischemic attack (TIA). 1 Direct oral anticoagulants (DOACs) including the thrombin inhibitor, dabigatran, 3 and the factor Xa inhibitors, 4 apixaban, edoxaban, and rivaroxaban, have been proven to be at least as effective in preventing ischemic stroke and systemic embolism in patients with AF while having a lower risk of symptomatic intracranial hemorrhage (ICH).…”

“…In clinical practice, DOACs are often commenced earlier than in the aforementioned RCTs, 13 yet little is known about safety and effectiveness of this approach. [18][19][20][21][22][23][24][25] Thus, we compared the clinical benefit of DOAC and VKA in patients having AF with a recent ischemic stroke or transient ischemic attack (TIA).…”

Possible timing for anticoagulation therapy initiation in ischemic stroke patients with atrial fibrillation: further analysis of the hemorrhagic transformation index

“…Неврология, нейропсихиатрия, психосоматика. 2019; 11(2): [12][13][14][15][16][17][18][19][20][21] Фибрилляция предсердий (ФП) остается одной из главных причин ишемического инсульта (ИИ) во всем мире. Современные исследования показали, что ФП выявляется у 20-30% больных до, во время или вскоре после церебрального кардиоэмболического события, причем 13-26% всех ИИ связаны с неклапанной ФП [1,2].…”

Direct oral anticoagulants in the early phase of non‐valvular atrial fibrillation‐related ischemic stroke in very old patients undergoing systemic thrombolysis and/or mechanical thrombectomy

“…The size of the ischemic lesion was classified according to Early Recurrence and Cerebral Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation (RAF) and Early Recurrence and Major Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation Treated With Non-Vitamin K Oral Anticoagulants (RAF-NOAC) studies as small, medium and large anterior or posterior. 1,2 Hemorrhagic transformation (HT) was classified as either hemorrhagic infarction or parenchymal hematoma, as well as in the above-mentioned two studies. 1,2 We recorded the type and dose of DOAC administered, the time of its first administration after the AIS and the 90-day outcomes.…”

“…1,2 Hemorrhagic transformation (HT) was classified as either hemorrhagic infarction or parenchymal hematoma, as well as in the above-mentioned two studies. 1,2 We recorded the type and dose of DOAC administered, the time of its first administration after the AIS and the 90-day outcomes. Disability at hospital discharge and at 90-day follow up was assessed by using the modified Rankin Scale (mRS).…”