The neurologist's approach to cerebral infarct and transient ischaemic attack in patients receiving anticoagulant treatment for non‐valvular atrial fibrillation: <scp>ANITA</scp>‐<scp>FA</scp> study

Zapata-Wainberg, Gustavo; Masjuán, Jaime; Quintas, Sonia; Ximénez-Carrillo, Álvaro; Pastor, A. García; Zabaleta, Maite Martínez; Cardona, Pere; Guerrero, Mariana; Llull, Laura; Fernández, Lorena Benavente; Rodrigo, M. Castellanos; Egido, J.; Serena, Joaquı́n; Vivancos, José

doi:10.1111/ene.13792

Cited by 14 publications

(21 citation statements)

References 45 publications

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“…Interestingly, a recent study suggested that CMBs are an independent predictor of HT following IV thrombolytic therapy in acute ischaemic stroke [4]. This thought is particularly important in this study [1], especially considering that CMBs have not been shown to predict HT in the absence of IV thrombolysis [4].…”

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confidence: 85%

“…Secondly, did HAS-BLED scores have any correlation with increased HT in either group [1]? The HAS-BLED score is used to assess the 1-year risk of major bleeding in patients with atrial fibrillation [5].…”

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confidence: 96%

“…We read with interest the article by Zapata-Wainberg et al [1]. This study showed a significantly lower risk of symptomatic hemorrhagic transformation (HT) of acute ischaemic stroke in nonvalvular atrial fibrillation patients on direct oral anticoagulants (DOACs) than on patients on vitamin K antagonists (VKAs).…”

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confidence: 99%

“…First, the utilization of intravenous (IV) thrombolysis in the patients who were on VKAs was significantly higher than in those in the DOAC group (9.2% vs. 1.6%) [1]. It can be argued that the effect of thrombolytic therapy cannot be generalized to that of anticoagulant therapy, owing to the short duration of IV thrombolysis and the controlled nature of its administration.…”

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confidence: 99%

“…However, the independent association of IV thrombolysis with HT demonstrated in previous studies cannot be ignored. [2] Therefore, it is unclear in the methodology [1] if the results have been adjusted for IV thrombolysis in both VKA and DOAC groups or not. The latter would suggest that the observed increased risk of HT in patients on VKAs is merely by chance.…”

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confidence: 99%

See 4 more Smart Citations

The role of anticoagulant therapy in hemorrhagic transformation of acute ischaemic stroke in nonvalvular atrial fibrillation patients

Vilanilam

Badi

Vemireddy

et al. 2019

Euro J of Neurology

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confidence: 85%

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confidence: 96%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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The role of anticoagulant therapy in hemorrhagic transformation of acute ischaemic stroke in nonvalvular atrial fibrillation patients

Vilanilam

Badi

Vemireddy

et al. 2019

Euro J of Neurology

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Clinical Effectiveness of Direct Oral Anticoagulants vs Warfarin in Older Patients With Atrial Fibrillation and Ischemic Stroke

Xian

O’Brien

et al. 2019

JAMA Neurol

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IMPORTANCE Current guidelines recommend direct oral anticoagulants (DOACs) over warfarin for stroke prevention in patients with atrial fibrillation (AF) who are at high risk. Despite demonstrated efficacy in clinical trials, real-world data of DOACs vs warfarin for secondary prevention in patients with ischemic stroke are largely based on administrative claims or have not focused on patient-centered outcomes. OBJECTIVE To examine the clinical effectiveness of DOACs (dabigatran, rivaroxaban, or apixaban) vs warfarin after ischemic stroke in patients with AF. DESIGN, SETTING, AND PARTICIPANTS This cohort study included patients who were 65 years or older, had AF, were anticoagulation naive, and were discharged from 1041 Get With The Guidelines-Stroke-associated hospitals for acute ischemic stroke between October 2011 and December 2014. Data were linked to Medicare claims for long-term outcomes (up to December 2015). Analyses were completed in July 2018. EXPOSURES DOACs vs warfarin prescription at discharge. MAIN OUTCOMES AND MEASURES The primary outcomes were home time, a patient-centered measure defined as the total number of days free from death and institutional care after discharge, and major adverse cardiovascular events. A propensity score-overlap weighting method was used to account for differences in observed characteristics between groups. RESULTS Of 11 662 survivors of acute ischemic stroke (median [interquartile range] age, 80 [74-86] years), 4041 (34.7%) were discharged with DOACs and 7621 with warfarin. Except for National Institutes of Health Stroke Scale scores (median [interquartile range], 4 [1-9] vs 5 [2-11]), baseline characteristics were similar between groups. Patients discharged with DOACs (vs warfarin) had more days at home (mean [SD], 287.2 [114.7] vs 263.0 [127.3] days; adjusted difference, 15.6 [99% CI, 9.0-22.1] days) during the first year postdischarge and were less likely to experience major adverse cardiovascular events (adjusted hazard ratio [aHR], 0.89 [99% CI, 0.83-0.96]). Also, in patients receiving DOACs, there were fewer deaths (aHR, 0.88 [95% CI, 0.82-0.95]; P < .001), all-cause readmissions (aHR, 0.93 [95% CI, 0.88-0.97]; P = .003), cardiovascular readmissions (aHR, 0.92 [95% CI, 0.86-0.99]; P = .02), hemorrhagic strokes (aHR, 0.69 [95% CI, 0.50-0.95]; P = .02), and hospitalizations with bleeding (aHR, 0.89 [95% CI, 0.81-0.97]; P = .009) but a higher risk of gastrointestinal bleeding (aHR, 1.14 [95% CI, 1.01-1.30]; P = .03). CONCLUSIONS AND RELEVANCE In patients with acute ischemic stroke and AF, DOAC use at discharge was associated with better long-term outcomes relative to warfarin.

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Non-Vitamin K Antagonist Oral Anticoagulants in Secondary Stroke Prevention in Atrial Fibrillation Patients: An Updated Analysis by Adding Observational Studies

Liu

et al. 2020

Cardiovasc Drugs Ther

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The neurologist's approach to cerebral infarct and transient ischaemic attack in patients receiving anticoagulant treatment for non‐valvular atrial fibrillation: ANITA‐FA study

Cited by 14 publications

References 45 publications

The role of anticoagulant therapy in hemorrhagic transformation of acute ischaemic stroke in nonvalvular atrial fibrillation patients

The role of anticoagulant therapy in hemorrhagic transformation of acute ischaemic stroke in nonvalvular atrial fibrillation patients

Clinical Effectiveness of Direct Oral Anticoagulants vs Warfarin in Older Patients With Atrial Fibrillation and Ischemic Stroke

Non-Vitamin K Antagonist Oral Anticoagulants in Secondary Stroke Prevention in Atrial Fibrillation Patients: An Updated Analysis by Adding Observational Studies

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