Oral anticoagulation in patients with atrial fibrillation and acute ischaemic stroke: design and baseline data of the prospective multicentre Berlin Atrial Fibrillation Registry

Abstract

Aims The Berlin Atrial Fibrillation Registry was designed to analyse oral anticoagulation (OAC) prescription in patients with atrial fibrillation (AF) and acute ischaemic stroke. Methods and results This investigator-initiated prospective multicentre registry enrolled patients at all 16 stroke units located in Berlin, Germany. The ongoing telephone follow-up is conducted centrally and will cover 5 years per patient. Within 2014 and 2016, 1080 patients gave written informed consent and 1048 patients were available for analysis. Median age was 77 years [interquartile range (IQR) 72–83], 503 (48%) patients were female, and 254 (24%) had a transient ischaemic attack (TIA). Overall, 470 (62%) out of 757 patients with known AF and a (pre-stroke) CHA2DS2-VASc ≥ 1 were anticoagulated at the time of stroke. At hospital discharge, 847 (81.3%) of 1042 patients were anticoagulated. Thereof 710 (68.1%) received a non-vitamin K-dependent oral anticoagulant (NOAC) and 137 (13.1%) a vitamin K antagonist (VKA). Pre-stroke intake of a NOAC [odds ratio (OR) 15.6 (95% confidence interval, 95% CI 1.97–122)] or VKA [OR 0.04 (95% CI 0.02–0.09)], an index TIA [OR 0.56 (95% CI 0.34–0.94)] rather than stroke, heart failure [OR 0.49 (95% CI 0.26–0.93)], and endovascular thrombectomy at hospital admission [OR 12.9 (95% CI 1.59–104)] were associated with NOAC prescription at discharge. Patients’ age or AF type had no impact on OAC or NOAC use, respectively. Conclusion About 60% of all registry patients with known AF received OAC at the time of stroke or TIA. At hospital discharge, more than 80% of AF patients were anticoagulated and about 80% of those were prescribed a NOAC.

Long-Term Anticoagulation in Secondary Ischemic Stroke Prevention: The Prospective Multicenter RESTAIC Registry

“…Another interesting finding in our study was the analysis of the switches to another anticoagulant. Before the index stroke, one third of the total cohort was on OAC, mostly VKA, and about 61% of them had INR values below the recommended range, consistent with other studies (21,51). Therefore, in the majority of patients previously treated with anticoagulants, the index stroke was considered a therapeutic failure, and a change to a DOAC was indicated.…”

“…Taking into account that stroke patients are at high risk both of ischemic and hemorrhagic strokes, and prevention of both are the main objectives in this specific population, it seems necessary to monitor the effects of OAC in non-selected patients in clinical practice. Several registries have been published in recent years to study the use of the various oral anticoagulant treatments in stroke patients (18)(19)(20)(21)(22)(23)(24)(25)(26), mainly evaluating clinical outcomes such as stroke recurrence, cerebral hemorrhage, or functional outcome. Other published registries were focused on the use of radiological markers such as cerebral microbleeds or white matter hyperintensities in order to stratify the hemorrhagic risk in this specific population (27,28).…”

Off-label-dosing of non-vitamin K-dependent oral antagonists in AF patients before and after stroke: results of the prospective multicenter Berlin Atrial Fibrillation Registry

“…The design of the “Berlin Atrial Fibrillation Registry” was described in detail previously [ 9 ]. Patients with acute ischemic stroke/TIA, admitted to 1 of the 16 stroke units in Berlin, Germany, were eligible for inclusion, if patients were able to give informed consent within the in-hospital stay and either had a history of AF or a first episode of AF in-hospital.…”

“…Present guidelines strongly recommend oral anticoagulation using a NOAC or a VKA for stroke prevention in patients with AF and prior ischemic stroke [6][7][8]. Registry data showed a steep increase of NOAC use for secondary stroke prevention after ischemic stroke/TIA in AF patients, even in elderly stroke patients with AF [5,[9][10][11][12]. Treating physicians are advised to prescribe the guideline-recommended in-label NOAC dosage in each patient, taking patients' age (for dabigatran, apixaban, and edoxaban), renal function (dabigatran, apixaban, rivaroxaban, and edoxaban) as well as body weight (apixaban and edoxaban) into account [13].…”

“…The Berlin Atrial Fibrillation Registry is a multicenter prospective registry including AF patients with acute ischemic stroke/TIA. First results on factors associated with oral anticoagulation use were published previously [ 9 ]. In the present analysis, we focus on prevalence and predictors of NOAC under-dosing in AF patients before and after the index stroke.…”