Ischemic stroke in oral anticoagulated patients with atrial fibrillation

D’Anna, Lucio; Filippidis, Filippos; Harvey, Kirsten; Korompoki, Eleni; Veltkamp, Roland

doi:10.1111/ane.13552

Cited by 4 publications

(3 citation statements)

References 45 publications

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“…Mechanical thrombectomy rates were also lower among patients on AC. This differs from prior studies reporting increased rates of mechanical thrombectomy in this population as a reperfusion strategy since of intravenous thrombolysis is usually avoided (3,4,20,25). As guidelines recommend mechanical thrombectomy particularly in the setting of acute ischemic stroke and concomitant LVO (29), perhaps as anticoagulated patients presented with LVO less frequently, they required mechanical thrombectomy less often.…”

Section: Discussioncontrasting

confidence: 96%

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In-hospital Outcomes of Acute Ischemic Stroke in Atrial Fibrillation Patients on Anticoagulation: A Retrospective Analysis

Vasquez,

Lambrakos,

Velasquez

et al. 2023

Preprint

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BackgroundLong-term anticoagulation (AC) therapy reduces the risk of stroke in patients with Atrial Fibrillation (AF). Data on the impact of AC on in-hospital stroke outcomes is lacking.MethodsThe National Inpatient Sample was used to identify adult inpatients with AF and a primary diagnosis of ischemic stroke between 2016 and 2020. Data was stratified between patients on AC users and nonusers. A multivariate regression model was used to describe the in-hospital outcomes, adjusting for significant comorbidities.ResultsA total of 655,540 patients with AF and a diagnosis of ischemic stroke were included, of which 194,560 (29.7%) were on long-term AC. Patients on AC tended to be younger (mean age, 77 vs 78), had a higher average CHA2DS2VASc score (4.48 vs 4.20), higher rates of hypertension (91% vs 88%), hyperlipidemia (64% vs 59%), and heart failure (34% vs 30%) compared to patients not on long-term AC. Use of AC was associated with decreased in-hospital mortality (aOR [95% CI]: 0.62 [0.60 - 0.63]), decreased stroke severity (mean NIHSS, 8 vs 10), decreased use of tPA (aOR 0.42 [0.41 - 0.43]), mechanical thrombectomy (aOR 0.85 [0.83 - 0.87]), hemorrhagic conversion (aOR 0.69 [0.67 - 0.70]), gastrointestinal bleeding (aOR 0.74 [0.70 - 0.77]), and discharge to skilled nursing facilities (aOR 0.90 [0.89 - 0.91]), compared to patients not on AC (P<0.001 for all comparisons).ConclusionAmong patients with AF admitted with acute ischemic stroke, AC use prior to stroke was associated with decreased in-hospital mortality, decreased stroke severity, decreased discharge to SNF, and fewer stroke-related and bleeding complications.

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Section: Discussioncontrasting

confidence: 96%

“…Our data indicate that on third of AF patients were anticoagulated at the stroke onset, consistent with previous research (4,12,19,20). These patients typically had more comorbidities and higher average CHADS2VAS2C scores compared to those not on AC.…”

Section: Discussionsupporting

confidence: 92%

In-hospital Outcomes of Acute Ischemic Stroke in Atrial Fibrillation Patients on Anticoagulation: A Retrospective Analysis

Vasquez,

Lambrakos,

Velasquez

et al. 2023

Preprint

View full text Add to dashboard Cite

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“…Stroke is a common clinical disorder of cerebral blood circulation, generally divided into cerebral infarction and intracerebral hemorrhage. If the diseases occur within 6 hours, it is called the hyperacute phase [ 20 , 21 ]. Clinically, the optimal treatment time for stroke is 3–6 hours, in which the best prognosis can be achieved for patients.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Value of Image Features of Magnetic Resonance Imaging in Intracranial Hemorrhage and Cerebral Infarction

Tang

Zeng

Zhao

2022

Contrast Media & Molecular Imaging

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This study aimed to investigate the differential diagnosis value of routine magnetic resonance imaging (MRI) and magnetic resonance diffusion-weighted imaging (DWI) in hyperacute intracranial hemorrhage (HICH) and hyperacute cerebral infarction (HCI). Fifty-five patients with HICH were set as group A, and 55 patients with HCI were selected as group B. All the patients underwent routine MRI and DWI examinations. The morphological distribution and signal characteristics (low, high, or mixed) of the lesions in the two groups were recorded. The diagnostic accuracy, sensitivity, and specificity of routine MRI and DWI were compared for distinguishing HICH and HCI. The results suggested that the lesions in patients with HICH were mainly manifested as mixed signals (40 cases), while those in patients with HCI showed high signals (48 cases). HICH occurred in the basal ganglia in 44 cases, in the brain stem in 6 cases, in the cerebellum in 4 cases, in the cerebral cortex in 0 cases, and in the corpus callosum in 1 case. HCI occurred in the basal ganglia area, brain stem, cerebellum, cerebral cortex, and corpus callosum in 5, 3, 35, 12, and 0 cases, respectively. The diagnostic accuracy, specificity, and sensitivity of DWI for HICH and HCI were significantly higher than those of routine MRI P < 0.05 . It was indicated that compared with routine MRI, DWI was more effective in the diagnosis of HICH and HCI, with clearer and more accurate images and better diagnostic performance.

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Contemporary outcomes of acute ischemic stroke in atrial fibrillation patients on anticoagulation

Vasquez,

Lambrakos,

Velasquez

et al. 2024

Journal of Stroke and Cerebrovascular Diseases

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Ischemic stroke in oral anticoagulated patients with atrial fibrillation

Cited by 4 publications

References 45 publications

In-hospital Outcomes of Acute Ischemic Stroke in Atrial Fibrillation Patients on Anticoagulation: A Retrospective Analysis

In-hospital Outcomes of Acute Ischemic Stroke in Atrial Fibrillation Patients on Anticoagulation: A Retrospective Analysis

Diagnostic Value of Image Features of Magnetic Resonance Imaging in Intracranial Hemorrhage and Cerebral Infarction

Contemporary outcomes of acute ischemic stroke in atrial fibrillation patients on anticoagulation

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