Relation of Effective Anticoagulation in Patients With Atrial Fibrillation to Stroke Severity and Survival (from the National Acute Stroke Israeli Survey [NASIS])

Schwammenthal, Yvonne; Bornstein, Natan M.; Schwammenthal, Ehud; Schwartz, Roseline; Goldbourt, Uri; Tsabari, Rakefet; Koton, Silvia; Grossman, Ehud; Tanné, David

doi:10.1016/j.amjcard.2009.09.050

Cited by 69 publications

(77 citation statements)

References 16 publications

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“…Anticoagulant treatment with a vitamin K antagonist (VKA) has been proven to reduce the incidence of ischemic stroke for patients with AF 4. Moreover, VKA therapy, especially with sufficient anticoagulation, has been reported to reduce the severity and improve clinical outcomes when patients with AF suffer ischemic stroke, compared with those on no anticoagulation 5, 6, 7, 8. Decreasing the clot size, to avoid major artery occlusion and therefore small infarct volume is considered the main mechanism by which VKA therapy alleviates initial symptoms in acute ischemic stroke patients 9, 10, 11, 12…”

Section: Introductionmentioning

confidence: 99%

Prior Direct Oral Anticoagulant Therapy is Related to Small Infarct Volume and No Major Artery Occlusion in Patients With Stroke and Non‐Valvular Atrial Fibrillation

Sakamoto

Okubo

Sekine

et al. 2018

JAHA

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BackgroundThe aims of the present study were to investigate the relationships between prior direct oral anticoagulant (DOAC) therapy and infarct volume and the site of arterial occlusion in patients with acute ischemic stroke and non‐valvular atrial fibrillation.Methods and ResultsFrom March 2011 through November 2016, consecutive patients with acute ischemic stroke in the middle cerebral artery territory and non‐valvular atrial fibrillation were recruited. The infarct volume was assessed semi‐automatically using initial diffusion‐weighted imaging, and the arterial occlusion site was evaluated on magnetic resonance angiography. The effect of prior DOAC treatment on the site of arterial occlusion was assessed by multivariate ordinal logistic regression analysis. A total of 330 patients (149 women; median age 79 [quartiles 71–86] years; median National Institutes of Health Stroke Scale score 11 [4–21]) were enrolled. Of these, 239 were on no anticoagulant, 40 were undertreated with a vitamin K antagonist (VKA), 22 were sufficiently treated with VKA (PT‐INR ≥1.6), and 29 were on a DOAC before the acute ischemic stroke. The infarct volume on admission differed among the groups (median 14.5 [2.0–59.8] cm3 in patients with no anticoagulation, 24.8 [2.1–63.0] in undertreated VKA, 1.3 [0.3–13.5] in sufficient VKA, and 2.3 [0.5–21.0] in DOAC, P=0.001). Multivariate analysis showed that prior DOAC treatment was independently and negatively associated with more proximal artery occlusion (odds ratio [OR] 0.34, P=0.015), compared with no anticoagulant.Conclusions DOAC treatment before the event was associated with smaller infarct volume and decreased risk of greater proximal artery occlusion in acute ischemic stroke patients with non‐valvular atrial fibrillation, compared with no anticoagulation.

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Section: Introductionmentioning

confidence: 99%

Prior Direct Oral Anticoagulant Therapy is Related to Small Infarct Volume and No Major Artery Occlusion in Patients With Stroke and Non‐Valvular Atrial Fibrillation

Sakamoto

Okubo

Sekine

et al. 2018

JAHA

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“…При этом больные нашего исследова-ния не являются искусственно отобранной ко-гортой, а представляют собой традиционных пациентов врача-кардиолога. При сравнении с данными других исследований и регистров, посвященных рутинной практике [6][7][8][9][10], па-циенты нашей выборки моложе, но в большин-стве своем тяжелее. Их средний возраст соста-вил 64,6 года, число пациентов старше 75 лет -лишь 12%, но при этом средняя сумма баллов по шкале CHA 2 DS 2 -VASc составила 3,2 ± 1,76.…”

Section: Discussionunclassified

“…Несмотря на меньшую частоту инсультов в группе варфарина, продемонстрированную в клинических исследованиях [11][12][13], когорт-ные исследования и регистры, выполненные в реальной клинической практике, демонстри-руют схожую с нашими данными частоту со-бытий при длительном наблюдении [8,10,[15][16][17]. Так, в исследовании [16], включавшем па-циентов с ФП, подвергнутых плановым чре-скожным коронарным вмешательствам, часто-та ИИ составила 2,6% в год, что согласуется с нашими данными.…”

Section: Discussionunclassified

“…Действительно, ИИ на фоне адекват-ной антикоагулянтной терапии, характеризу-ются меньшей тяжестью и лучшим прогнозом [10,[17][18], что позволяет говорит о том, что варфарин способен не только снизить частоту развития инсульта, но и уменьшить тяжесть его проявлений.…”

Section: Discussionunclassified

“…К сожалению, даже при отработан-ной системе патронажа достичь целевых зна-чений удается не всегда, т. к. стабильность зна-чений МНО зависит от многих объективных и субъективных факторов [10,17,30,[39][40][41][42]. В крупных РКИ, посвященных изучению прямых пероральных антикоагулянтов [11][12][13], в груп-пах больных, принимающих варфарин, сред-нее значение TTR составляло 58-67%.…”

Section: Discussionunclassified

See 2 more Smart Citations

THE EFFICACY OF LONG-TERM WARFARIN THERAPY: THE IMPACT ON THE INCIDENCE OF ISCHEMIC CEREBROVASCULAR DISORDERS AND CLINICAL PREDICTORS OF DEVELOPING SUCH DISORDERS. (Results of a prospective 10-year follow-up study)

et al. 2017

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CHA2DS2-VASc score and prognosis in ischemic strokes with atrial fibrillation

et al. 2011

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The CHA(2)DS(2)-VASc score was developed to improve stroke risk stratification in atrial fibrillation (AF) patients. We sought to analyze the distribution and prognostic value of the CHA(2)DS(2)-VASc score in a cohort of ischemic stroke patients with AF. In total, 439 consecutive stroke patients with AF were studied. The CHA(2)DS(2)-VASc score was calculated according to clinical status before stroke onset. Poor outcome was defined as a modified Rankin score of 3 to 6 at 3 months. Association between CHA(2)DS(2)-VASc score and poor outcome was analyzed using logistic regression analysis. In 95.6% of patients, CHA(2)DS(2)-VASc was >1 and only 41.8% of those with previously diagnosed AF were using oral anticoagulation at the time of the stroke. Poor outcome was found in 53.1% of the patients. In univariate analysis age, female sex, current smoking, previous stroke, CHA(2)DS(2)-VASc score, and stroke severity were associated with outcome. In multivariate analysis, CHA(2)DS(2)-VASc score was independently associated with poor outcome [OR 1.36 (95% CI: 1.14-1.62), P = 0.001] as well as NIHSS [OR 1.22 (95% CI: 1.17-1.26), P < 0.001]. After removing stroke severity, therapeutic anticoagulation was also associated with stroke prognosis [OR 0.45 (95% CI: 0.23-0.86), P = 0.016]. Most patients with ischemic stroke and AF have a high CHA(2)DS(2)-VASc score. Independent of stroke severity, CHA(2)DS(2)-VASc score is associated with 3-month outcome. Despite all the available information and guidelines, our AF patients are clearly undertreated.

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Relation of Effective Anticoagulation in Patients With Atrial Fibrillation to Stroke Severity and Survival (from the National Acute Stroke Israeli Survey [NASIS])

Cited by 69 publications

References 16 publications

Prior Direct Oral Anticoagulant Therapy is Related to Small Infarct Volume and No Major Artery Occlusion in Patients With Stroke and Non‐Valvular Atrial Fibrillation

Prior Direct Oral Anticoagulant Therapy is Related to Small Infarct Volume and No Major Artery Occlusion in Patients With Stroke and Non‐Valvular Atrial Fibrillation

THE EFFICACY OF LONG-TERM WARFARIN THERAPY: THE IMPACT ON THE INCIDENCE OF ISCHEMIC CEREBROVASCULAR DISORDERS AND CLINICAL PREDICTORS OF DEVELOPING SUCH DISORDERS. (Results of a prospective 10-year follow-up study)

CHA2DS2-VASc score and prognosis in ischemic strokes with atrial fibrillation

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