Secondary stroke prevention and guideline adherent antithrombotic treatment in patients with atrial fibrillation: Insights from the Gulf Survey of atrial fibrillation events (Gulf SAFE)

Miyazawa, Kazuo; Li, Yanguang; Rashed, Wafa; Mahmeed, Wael Al; Shehab, Abdullah; Zubaid, Mohammad; Lip, Gregory Y.H.

doi:10.1016/j.ijcard.2018.07.120

Cited by 11 publications

(10 citation statements)

References 34 publications

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“…Previous studies have reported that 20–30% of patients admitted to hospitals with stroke and AF with an indication for OACs were taking antiplatelet agents alone until recently [41,42]. In our study, most AF-related stroke patients (95.5%) without atherosclerosis were treated with anticoagulants.…”

Section: Discussionmentioning

confidence: 56%

“…Therefore, physicians must carefully compare risks and benefits to determine the specific antithrombotic agent. Characteristically, several physicians are reluctant to prescribe OACs, due to which there are a large number of cases in actual clinical practice where antiplatelet agents have been administered to patients with AF-related stroke and atherosclerotic diseases [41,42]. Nevertheless, no studies have directly compared anticoagulation and antiplatelet therapy for secondary prevention of stroke in patients with AF and atherosclerotic diseases.…”

Section: Discussionmentioning

confidence: 99%

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Baseline D-Dimer Levels as a Risk Assessment Biomarker for Recurrent Stroke in Patients with Combined Atrial Fibrillation and Atherosclerosis

Choi

Seo

Park

et al. 2019

JCM

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Background: We investigated the effect of D-dimer levels and efficacy of different antithrombotic therapies according to the baseline D-dimer levels on recurrent stroke in patients with atrial fibrillation (AF)-related stroke and atherosclerosis. Methods: We enrolled 1441 patients with AF-related stroke and atherosclerosis in this nationwide multicenter study. The primary outcome measure was the occurrence of recurrent ischemic stroke over a 3-year period. Results: High D-dimer levels (≥2 μg/mL) were significantly associated with higher risk of recurrent ischemic stroke (adjusted hazard ratio (HR), 1.80; 95% confidence interval (CI), 1.13–2.84; p = 0.012). The risk of recurrent stroke was similar between the anticoagulant and the antiplatelet groups in all subjects (adjusted HR, 0.78; 95% CI, 0.46–1.32; p = 0.369). However, in patients with high D-dimer levels (≥2 μg/mL), risk of recurrent stroke was significantly lower in the anticoagulant group than in the antiplatelet group (adjusted HR, 0.40; 95% CI, 0.18–0.87; p = 0.022). Conclusion: Our findings suggested that baseline D-dimer levels could be used as a risk assessment biomarker of recurrent stroke in patients with AF-related stroke and atherosclerosis. High D-dimer levels would facilitate the identification of patients who are more likely to benefit from anticoagulants to ensure secondary prevention of stroke.

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Baseline D-Dimer Levels as a Risk Assessment Biomarker for Recurrent Stroke in Patients with Combined Atrial Fibrillation and Atherosclerosis

Choi

Seo

Park

et al. 2019

JCM

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“…On the other hand, a recent hospital-based study conducted in six Gulf countries reported that nearly half of the patients received guideline non-adherent treatment, with patients receiving over-(25.6%) and undertreatment (25.4%) in similar rates. [66] This study did not consider the HAS-BLED score but omission of OACs were considered appropriate in patients at high risk of stroke when contraindications were reported. A study in Israel also reported undertreatment as high as 62.9%.…”

Section: Middle Eastmentioning

confidence: 98%

“…Three studies from the Middle East reported guideline non-adherence. [30,62,66] One study from Iran reported that only 2.5% of patients received guideline non-adherent treatment. [30] Compared to the other two studies [62,66], this study had a lower sample size.…”

Section: Middle Eastmentioning

confidence: 99%

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Non-adherence to Thromboprophylaxis Guidelines in Atrial Fibrillation: A Narrative Review of the Extent of and Factors in Guideline Non-adherence

Gebreyohannes

Salter

Chalmers

et al. 2020

Am J Cardiovasc Drugs

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Middle East Treatment Strategies and Clinical Outcomes in Patients with Atrial Fibrillation: One-Year Follow-up Data from Garfield-AF Study

et al. 2021

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Secondary stroke prevention and guideline adherent antithrombotic treatment in patients with atrial fibrillation: Insights from the Gulf Survey of atrial fibrillation events (Gulf SAFE)

Cited by 11 publications

References 34 publications

Baseline D-Dimer Levels as a Risk Assessment Biomarker for Recurrent Stroke in Patients with Combined Atrial Fibrillation and Atherosclerosis

Baseline D-Dimer Levels as a Risk Assessment Biomarker for Recurrent Stroke in Patients with Combined Atrial Fibrillation and Atherosclerosis

Non-adherence to Thromboprophylaxis Guidelines in Atrial Fibrillation: A Narrative Review of the Extent of and Factors in Guideline Non-adherence

Middle East Treatment Strategies and Clinical Outcomes in Patients with Atrial Fibrillation: One-Year Follow-up Data from Garfield-AF Study

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