Oral anticoagulants and non-cardioembolic stroke prevention

Schächter, Michael; Tran, Huyen; Anand, Sonia S.

doi:10.1177/1358863x07086191

Cited by 1 publication

(4 citation statements)

References 40 publications

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“…20 Furthermore, it has been shown that the NIHSS score predicts the likelihood of recovery after stroke. 21 Accordingly, in our study, cardioembolic strokes were associated with a higher admission NIHSS (median 8.5 [IQR: [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] vs. 3 [1][2][3][4][5][6][7][8], p < 0.001). However, we did not find an association of stroke etiology and likelihood of favorable outcome.…”

Section: Discussionmentioning

confidence: 56%

“…From the total of 230 patients included in this study, 150 (65.2%) had a cardioembolic stroke (AF without other competing mechanism). Compared to patients with stroke of undetermined mechanism, cardioembolic stroke patients had more severe strokes with median NIHSS scores, 3 (1-8) versus 8.5 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) respectively, and were more commonly treated with reperfusion therapies: intravenous tissue plasminogen activator (IV tPA), 8.0 versus 2.5%, and mechanical thrombectomy (MT) 14.0 versus 3.8%, respectively (►Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…Resultados Nós incluímos 230 pacientes, com uma idade média 76,9 anos (DP AE 11.3), 52.2% homens, com um escore mediano do National Institute of Health Stroke Scale (NIHSS) de 7 (IIQ 2-16). Pacientes com AVC cardioembólicos (65,2%) tiveram um escore de NIHSS mediano mais alto 8,5 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) versus 3 (1-8), e com maior chance de tratamento com terapias de reperfusão. O desfecho favorável ocorreu em 64 pacientes (27,8%) e a mortalidade institucional foi de 15,2% no total.…”

Section: Introductionunclassified

“…10,11 In a metanalysis comparing oral anticoagulants versus control/placebo or antiplatelet agents in noncardioembolic stroke patients there was no benefit of anticoagulation therapy to prevent death, recurrent stroke or myocardial infarction (MI), and an increased risk of major bleed. 12 Furthermore, two trials tested direct oral anticoagulants (DOAC) versus antiplatelet agents in patients with an embolic neuroimaging phenotype but no documented embolic source, and again no benefit of anticoagulation was shown. 13,14 Many believe that secondary prophylaxis should be tailored according to the presumed etiologic mechanism.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of recurrent stroke in patients with atrial fibrillation according to presumed etiology

et al. 2023

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Background Atrial fibrillation (AF) is a potent risk factor for stroke. The presence of competing etiologies can modify disease outcomes and demand different treatment strategies. Objectives The primary purpose of the study was to examine the differences in outcomes for patients with AF admitted with a recurrent stroke, stratified according to the presumed etiology of the stroke. Methods We analyzed AF patients admitted for a recurrent ischemic stroke in an academic comprehensive stroke center. Recurrent strokes were categorized as “Cardioembolic”, meaning AF without any competing mechanism, versus “Undetermined” etiology due to competing mechanisms. We used logistic regression to test the association between recurrent stroke etiology and favorable outcome (discharge home), after accounting for important covariates. Results We included 230 patients, with a mean age 76.9 (SD ± 11.3), 52.2% male, median National Institute of Health Stroke Scale (NIHSS) score of 7 (IQR 2–16). Patients with cardioembolic stroke (65.2%) had higher median NIHSS 8.5 (3–18) versus 3 (1–8) and were more likely to be treated with reperfusion therapies. The favorable outcome was reached by 64 patients (27.8%), and in-hospital mortality was 15.2% overall. After adjustment, there was no difference in outcome between patients with cardioembolic versus undetermined stroke etiology (odds ratio for discharge home: 1.41; 95% CI: 0.65–3.15). Conclusions In this single-center sample of AF patients with history of stroke, there was no difference in discharge outcomes between those with cardioembolic and those with undetermined stroke etiology. This question warrants examination in larger samples to better understand the importance of the stroke mechanism and secondary prophylaxis.

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