The AtRial Cardiopathy and Antithrombotic Drugs In prevention After cryptogenic stroke randomized trial: Rationale and methods

Rationale Recent data suggest that a thrombogenic atrial substrate can cause stroke in the absence of atrial fibrillation. Such an atrial cardiopathy may explain some proportion of cryptogenic strokes. Aims The aim of the ARCADIA trial is to test the hypothesis that apixaban is superior to aspirin for the prevention of recurrent stroke in subjects with cryptogenic ischemic stroke and atrial cardiopathy. Sample size estimate 1100 participants. Methods and design Biomarker-driven, randomized, double-blind, active-control, phase 3 clinical trial conducted at 120 U.S. centers participating in NIH StrokeNet. Population studied Patients ≥ 45 years of age with embolic stroke of undetermined source and evidence of atrial cardiopathy, defined as ≥ 1 of the following markers: P-wave terminal force >5000 µV × ms in ECG lead V1, serum NT-proBNP > 250 pg/mL, and left atrial diameter index ≥ 3 cm/m2 on echocardiogram. Exclusion criteria include any atrial fibrillation, a definite indication or contraindication to antiplatelet or anticoagulant therapy, or a clinically significant bleeding diathesis. Intervention: Apixaban 5 mg twice daily versus aspirin 81 mg once daily. Analysis: Survival analysis and the log-rank test will be used to compare treatment groups according to the intention-to-treat principle, including participants who require open-label anticoagulation for newly detected atrial fibrillation. Study outcomes The primary efficacy outcome is recurrent stroke of any type. The primary safety outcomes are symptomatic intracranial hemorrhage and major hemorrhage other than intracranial hemorrhage. Discussion ARCADIA is the first trial to test whether anticoagulant therapy reduces stroke recurrence in patients with atrial cardiopathy but no known atrial fibrillation.

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Abstract W MP65: Moderate to Severe Left Atrial Enlargement is Associated with Cardioembolic or Cryptogenic Stroke Recurrence in a Multiethnic Cohort: The Northern Manhattan Study

Stroke ◽

10.1161/str.46.suppl_1.wmp65 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Shadi Yaghi ◽

Yeseon P Moon ◽

Consuelo Mora-McLaughlin ◽

Joshua Z Willey ◽

Marco R Di Tullio ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Left Atrial ◽

Recurrent Stroke ◽

Cryptogenic Stroke ◽

Cardioembolic Stroke ◽

Stroke Recurrence ◽

Stroke Patients ◽

Stroke Subtypes ◽

Multiethnic Cohort

Background: While left atrial (LA) enlargement increases incident stroke risk, the association with recurrent stroke is unclear. Our aim was to determine the association of LA enlargement (LAE) with stroke recurrence risk and recurrent stroke subtypes likely related to embolism (cryptogenic or cardioembolic). Methods: We enrolled 655 first ischemic stroke patients in the Northern Manhattan Stroke Study. LA size was measured by two-dimensional echocardiogram as part of the clinical evaluation and patients were followed annually for up to 5 years. LA size adjusted for sex and body surface area was categorized into three groups: normal (52.7%), mild LAE (31.6%), and moderate to severe LAE (15.7%). The outcomes were total recurrent stroke, and recurrent combined cryptogenic or cardioembolic stroke. Cox proportional hazard models assessed the association between LA size and risk of stroke recurrence. Results: Of 655 patients, LA size data was present in 529 (81%). Mean age was 69 ± 13 years; 46% were male and 18% had atrial fibrillation. Over a median of 4 years, recurrent stroke occurred in 83 patients (16%), 29 were cardioembolic or cryptogenic stroke. After adjusting for baseline demographics and risk factors including atrial fibrillation and congestive heart failure, compared to normal LA size, moderate to severe LAE was associated with greater risk of recurrent combined cardioembolic or cryptogenic stroke (adjusted HR 2. 99, 95% CI 1. 10 to 8.13), but not with risk of total stroke recurrence (adjusted HR 1.18, 95% CI 0.60 to 2.32). Mild LAE was not associated with either total stroke recurrence or the combined recurrent cryptogenic or cardioembolic stroke subtypes. Conclusion: Moderate to severe LAE is an independent marker of recurrent cardioembolic or cryptogenic stroke in a multiethnic cohort of ischemic stroke patients. Future research is needed to determine if anticoagulant use reduces the risk of recurrence in ischemic stroke patients with moderate to severe LAE.

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Association of Electrocardiographic P-Wave Markers and Atrial Fibrillation in Embolic Stroke of Undetermined Source

Cerebrovascular Diseases ◽

10.1159/000512179 ◽

2020 ◽

pp. 1-8

Author(s):

Tony Y.W. Li ◽

Leonard Leong L. Yeo ◽

Jamie Sin Ying Ho ◽

Aloysius S. Leow ◽

Mark Y. Chan ◽

...

Keyword(s):

Atrial Fibrillation ◽

Risk Stratification ◽

Ischaemic Stroke ◽

Recurrent Stroke ◽

Embolic Stroke ◽

P Wave ◽

Stroke Recurrence ◽

Atrial Remodeling ◽

P Wave Dispersion ◽

New Onset

Background: Several P-wave indices are thought to represent underlying atrial remodeling and have been associated with ischaemic stroke even in the absence of atrial fibrillation (AF). However, the utility of these P-wave indices in predicting outcomes in patients with embolic stroke of undetermined source (ESUS) has not been studied. The aim of this study is to examine these different P-wave indices towards predicting new-onset AF and stroke recurrence in a cohort of patients with ESUS, thereby demonstrating the value of these electrocardiographic markers for stroke risk stratification. Methods: Between October 2014 and October 2017, consecutive patients diagnosed with ESUS were followed for new-onset AF and ischaemic stroke recurrence. The various P-wave indices, namely, the P-terminal force in the precordial lead V1 (PTFV1), P-wave duration, P-wave dispersion, interatrial blocks, and P-wave axis, were assessed on the initial electrocardiogram on presentation and studied for their relation to eventual AF detection and recurrent stroke. Results: 181 ischaemic stroke patients with ESUS were recruited and followed up for a median duration of 2.1 years. An abnormal PTFV1 was associated with occult AF detection but not with recurrent ischaemic strokes. No significant association was observed between the other P-wave indices with either occult AF or stroke recurrence. Conclusion: PTFV1 is associated with AF detection but not recurrent strokes in ESUS patients and can be a useful electrocardiographic marker for further risk stratification in ESUS patients.

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Abstract TP435: Oral Anticoagulant Therapy Adherent to ESC Guidelines Reduces the Risk of Recurrent Stroke in Patients With Atrial Fibrillation

Stroke ◽

10.1161/str.51.suppl_1.tp435 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Mi-Yeon Eun ◽

Yang-Ha Hwang ◽

Man-Seok Park ◽

Joon-Tae Kim ◽

Kang-Ho Choi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Intracranial Hemorrhage ◽

Anticoagulant Therapy ◽

Oral Anticoagulant ◽

Oral Anticoagulant Therapy ◽

Major Hemorrhage ◽

Coronary Syndrome ◽

Esc Guidelines ◽

Secondary Outcomes

Introduction: Oral anticoagulant therapy is the primary treatment for the prevention of recurrent ischemic stroke in patients with atrial fibrillation (AF). Early anticoagulant therapy can be beneficial for the prevention of recurrent ischemic stroke, however, also can provoke symptomatic intracranial hemorrhage. This study aims to evaluate the efficacy and safety of standard oral anticoagulant therapy adherent to the European Society of Cardiology (ESC) guidelines compared to early oral anticoagulant therapy. Methods: Acute ischemic stroke patients with AF were included from a nationwide multicenter registry (K-ATTENTION). The primary outcome was recurrent all-type stroke during 90 days of follow-up. Secondary outcomes were major adverse cardiovascular events (MACE), ischemic stroke, intracranial hemorrhage, acute coronary syndrome, all-cause death, and major hemorrhage. The propensity score was used to match the baseline characteristics between the two treatment groups. Results: Among 2,321 eligible patients, 532 patients with standard anticoagulation were matched to 532 patients with early anticoagulation. Eight participants (1.5%) with standard anticoagulation had recurrence of all-type stroke compared with 19 (3.5%) of participants with early anticoagulation (odds ratio [OR], 0.41; 95% confidence interval [CI], 0.18-0.95; P=0.038). Standard anticoagulation was also associated with reduced risk of recurrent ischemic stroke (OR, 0.30; 95% CI, 0.11-0.82; P=0.019). Other secondary outcomes, including intracranial hemorrhage and major hemorrhage, appeared not to be informative. Conclusions: In conclusion, standard oral anticoagulant therapy adherent to ESC guidelines reduces the risk of recurrent all-type stroke and ischemic stroke compared to early oral anticoagulant therapy.

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Abstract W MP66: Rates of Ischemic Stroke after Intracranial Hemorrhage in a Population-Based Sample of Patients with Atrial Fibrillation

Stroke ◽

10.1161/str.46.suppl_1.wmp66 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Michael P Lerario ◽

Gino Gialdini ◽

Daniel Lapidus ◽

Mesha Shaw ◽

Babak Navi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Intracranial Hemorrhage ◽

Anticoagulant Therapy ◽

Stroke Risk ◽

Hazard Analysis ◽

Large Population ◽

Population Based ◽

Administrative Claims ◽

Index Visit

Introduction: Patients with atrial fibrillation (AF) who experience intracranial hemorrhage (ICH) often cannot tolerate anticoagulant therapy and presumably face a higher risk of thromboembolism. However, there are little population-based data on long-term rates of stroke after ICH in patients with AF. Methods: Using validated diagnosis codes and administrative claims data from all nonfederal acute care hospitals and emergency departments in California, Florida, and New York from 2005 to 2012, we identified patients at their first encounter with a recorded diagnosis of AF. We excluded patients with diagnoses of stroke or ICH prior to their index visit or a diagnosis of stroke at the index visit. A time-varying covariate was used to account for ICH (intracerebral or subarachnoid hemorrhage) at the index visit or during follow-up. Kaplan-Meier survival statistics were used to calculate cumulative rates of stroke, and Cox proportional hazard analysis was used to evaluate the relationship between incident ICH and stroke while adjusting for the CHA 2 DS 2 VASc score. Results: During a mean 3.2 years of follow-up among 2,376,207 patients with AF, 25,243 (1.06%) developed ICH and 93,183 (3.92%) developed stroke. The cumulative 1-year rate of stroke was 6.50% (95% CI, 6.06-6.96%) after ICH versus 2.22% (95% CI, 2.20-2.24) in those without ICH. ICH remained associated with higher stroke risk after adjusting for the CHA 2 DS 2 VASc score (HR, 2.29; 95% CI, 2.18-2.40). Among patients with ICH, stroke risk rose in step with the CHA 2 DS 2 VASc score. Conclusions: In a large population-based cohort, patients with AF faced a substantially higher risk of stroke after ICH. This risk rose proportionally with increasing CHA 2 DS 2 VASc score. These findings point to patients with AF and ICH as a vulnerable population who may especially benefit from therapeutic alternatives to anticoagulant therapy for preventing thromboembolism in AF.

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Abstract WP232: Biomarkers of Atrial Cardiopathy and Atrial Fibrillation Detection on Mobile Continuous Outpatient Telemetry After Cryptogenic Stroke

Stroke ◽

10.1161/str.48.suppl_1.wp232 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Denise Sebasigari ◽

Alexander Merkler ◽

Guo Yang ◽

Benjamin Kummer ◽

Gino Gialdini ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Cryptogenic Stroke ◽

Heart Rhythm ◽

Population Based ◽

Embolic Stroke ◽

P Wave ◽

Left Atrial Diameter ◽

New Diagnosis ◽

Rhythm Monitoring

Background: In population-based studies, biomarkers of atrial dysfunction or “cardiopathy” have been shown to be associated with embolic stroke risk. However, it is unclear if this risk is mediated by undiagnosed paroxysmal atrial fibrillation or flutter (AF). We aim to determine whether atrial cardiopathy biomarkers predict atrial fibrillation on continuous heart-rhythm monitoring after embolic stroke of undetermined source (ESUS). Methods: This was a single-center retrospective study including all patients who met consensus criteria for ESUS and who underwent 30 days of ambulatory heart-rhythm monitoring looking for AF between Jan 1 st , 2013 and Dec 31 st , 2015. We reviewed medical records for clinical, radiographic, and cardiac variables. The primary outcome was new diagnosis of AF detected during heart-rhythm monitoring. The primary predictors were atrial biomarkers: left atrial diameter on echocardiography, P-wave terminal force in ECG lead V1 , and PR interval on ECG. Multiple logistic regression was used to assess the relationship between atrial biomarkers and AF detection. Results: Among 196 eligible patients, 23 (11.7%) were diagnosed with AF. In unadjusted analyses, patients with AF were older (72.4 vs. 61.4 years, p < 0.001) and had larger left atrial diameter (39.2 vs. 35.7 mm, p = 0.03). In a multivariable model including variables significant on univariate analyses, the only predictor of AF was age ≥ 60 years (odds ratio, 3.0; 95% CI, 1.06-8.5; p = 0.04). Atrial biomarkers were not associated with AF detection. Conclusion: Atrial biomarkers were not associated with AF after ESUS. This suggests that previously reported associations between these markers and stroke may reflect independent cardiac pathways leading to stroke. Prospective studies are needed to investigate these mechanisms and study anticoagulation versus antiplatelet treatment for secondary stroke prevention in patients with ESUS and atrial cardiopathy.

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Abstract 19119: Concomitant Use of Antiplatelet Therapy with Edoxaban or Warfarin in Patients with Atrial Fibrillation in the ENGAGE AF-TIMI 48 Trial

Circulation ◽

10.1161/circ.130.suppl_2.19119 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Haiyan Xu ◽

Christian T Ruff ◽

Robert P Giugliano ◽

Sabina A Murphy ◽

Indravadan Patel ◽

...

Keyword(s):

Atrial Fibrillation ◽

Anticoagulant Therapy ◽

Major Bleeding ◽

Drug Exposure ◽

Proportional Hazards ◽

Absolute Risk ◽

Cox Proportional Hazards ◽

Relative Efficacy ◽

Double Blind ◽

Risk Of Bleeding

BACKGROUND: Patients with atrial fibrillation (AF) who receive both antiplatelet (AP) and anticoagulant therapy are at markedly higher risk of bleeding. The ENGAGE AF-TIMI 48 trial showed that both the high- (HD) and low-dose (LD) regimens of the once-daily factor Xa inhibitor edoxaban (Edox) were as effective as well-managed warfarin (Warf) (median TTR 68.4%) in preventing stroke or systemic embolism (SEE) with significant reductions in major bleeding and cardiovascular mortality. In this study, we assessed the relative efficacy and safety of Edox as compared with Warf in patients with and without concomitant use of AP therapy. METHODS: This was a randomized, double-blind, double-dummy trial comparing HD (60 mg daily, reduced to 30mg in patients with anticipated increased drug exposure) and LD (30 mg daily, reduced to 15mg) Edox with Warf. Dual AP therapy was prohibited while receiving study drug. Cox proportional hazards models were performed stratified by AP use at 3 months with treatment as a covariate. RESULTS: Of the 21,105 patients, 4,912 (23%) were receiving AP therapy at 3 months (92% aspirin). Patients who received concomitant AP therapy had higher rates of major bleeding compared to patients who did not (Fig). Both Edox regimens had similar relative efficacy in preventing stroke or SEE compared with Warf regardless of concomitant AP use (P int >0.10 for both) with consistent reductions in major bleeding (HD Edox vs. Warf: P int =0.91; LD Edox vs. Warf: P int =0.59). In patients randomized to LD Edox, AP therapy was associated with a further reduction in the net clinical outcome of death, stroke, SEE, or major bleeding (P int =0.02) compared with Warf. CONCLUSIONS: Regardless of concomitant AP therapy, both doses of Edox significantly reduced bleeding compared to well-managed Warf. The safety profile of Edox may be particularly attractive in patients with AF who receive a combination of AP and anticoagulant therapy because of higher absolute risk of bleeding.

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Higher Coated-Platelet Levels are Associated with Stroke Recurrence following Nonlacunar Brain Infarction

Journal of Cerebral Blood Flow & Metabolism ◽

10.1038/jcbfm.2012.168 ◽

2012 ◽

Vol 33 (2) ◽

pp. 287-292 ◽

Cited By ~ 21

Author(s):

Calin I Prodan ◽

Julie A Stoner ◽

Linda D Cowan ◽

George L Dale

Keyword(s):

Ischemic Stroke ◽

Cumulative Incidence ◽

Recurrent Stroke ◽

Brain Infarction ◽

Large Vessel ◽

Rank Test ◽

Stroke Recurrence ◽

Additional Tool ◽

Log Rank Test ◽

Dual Agonist

Coated-platelets are procoagulant platelets observed upon dual-agonist stimulation with collagen and thrombin. Coated-platelet levels are elevated in patients with nonlacunar (large-vessel) ischemic stroke and decreased in patients with spontaneous intracerebral hemorrhage as compared with controls. The purpose of this study was to investigate a possible relationship between coated-platelet levels and stroke recurrence in patients with nonlacunar ischemic stroke. We assayed coated-platelet levels in 190 consecutive patients with nonlacunar stroke who were followed for up to 12 months; 20 subjects experienced recurrent stroke. Subjects were categorized into tertiles of coated-platelet levels. The distributions of time-to-recurrent stroke were estimated for each tertile using cumulative incidence curves and compared statistically using a log-rank test. The cumulative incidence of recurrent stroke at 12 months differed among the coated-platelet tertiles: 2% for the first tertile (lowest coated-platelet levels), 18% for the second tertile, and 17% for the third tertile (overall log-rank test, P = 0.019). These data suggest that higher levels of coated-platelets, measured shortly after a nonlacunar stroke, are associated with an increased incidence of stroke recurrence. This observation offers an additional tool for identifying patients at highest risk for stroke recurrence following a nonlacunar (large-vessel) infarct.

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Early Anti-Coagulation after Ischemic Stroke due to Atrial Fibrillation is Safe and Prevents Recurrent Stroke

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2015.7 ◽

2015 ◽

Vol 42 (2) ◽

pp. 92-95 ◽

Cited By ~ 5

Author(s):

Christopher Hahn ◽

Michael D. Hill

Keyword(s):

Atrial Fibrillation ◽

Acute Stroke ◽

Recurrent Stroke ◽

Retrospective Chart Review ◽

Embolic Stroke ◽

Stroke Recurrence ◽

Index Stroke Volume ◽

Increase Risk ◽

Index Stroke ◽

Clinically Significant

AbstractBackground: Patients with acute cardio-embolic stroke from atrial fibrillation (AF) are at risk for recurrence with up to 50% of recurrent stroke occurring within two weeks of the index event. Anti-coagulation with heparinoids within 48 hours of stroke has been shown to increase risk of symptomatic intracranial hemorrhage (ICH) with no clear benefit on early stroke recurrence. Methods: This study was a retrospective chart review of consecutive patients who were admitted to the stroke service at the Foothills Medical Centre between 2009 and 2011. All patients with an acute stroke with a cardio-embolic etiology and a diagnosis of atrial fibrillation were reviewed. We hypothesized that anti-coagulation within two weeks of stroke, appropriately begun because of a diagnosis of AF, decreased rates of recurrent stroke without causing an increase in rates of symptomatic ICH. Results: Between 2009-2011, 324 patients were identified with cardio-embolic stroke secondary to AF. Within two weeks of stroke onset 61.4% (199/324) of patients were therapeutic on anti-coagulation. Patients who were anti-coagulated had a smaller median index stroke volume (3.2 ml vs 18.4 ml). Three (0.9%) patients suffered a clinically significant ICH. Recurrent stroke occurred in 11 patients (3.4%) within the two-week period. Therapeutic anti-coagulation within two weeks of initial stroke was associated with a decreased risk of recurrent stroke (RR 0.1, 95% CI 0.03-0.64). Conclusions: Anti-coagulation within two weeks of acute stroke in patients with AF appears to be safe among patients with smaller infarcts and prevents early recurrent infarction.

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P5350Atrial fibrillation prediction using P wave signal-averaged ECG in patients with embolic stroke of undetermined source

European Heart Journal ◽

10.1093/eurheartj/ehz746.0317 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S Shin ◽

M Jung ◽

J Song ◽

J Kim ◽

K Park ◽

...

Keyword(s):

Atrial Fibrillation ◽

Odds Ratio ◽

Unknown Origin ◽

Embolic Stroke ◽

P Wave ◽

Stroke Recurrence ◽

Wave Duration ◽

P Wave Duration ◽

Potential Association

Abstract Background Approximately 10–25% of ischemic strokes are of unknown origin. Determining their potential association with subclinical atrial fibrillation (SCAF) is important for proper secondary prevention. We investigated whether SCAF can be predicted by assessing the atrial substrate with signal-averaged electrocardiography (SAECG). Methods Between April 2015 and February 2018, we recruited 125 consecutive patients with embolic stroke of undetermined source (ESUS) and 125 patients with paroxysmal atrial fibrillation (AF) patients as control. All participants underwent P wave SAECG at baseline and ESUS patients were followed up with ECG and Holter ECG, at baseline, 3, 6, and 12 months after discharge, and every 12 months thereafter. Results In the ESUS group (69 males, 68.4±12.1 years), 32 (25.6%) patients were diagnosed with SCAF during follow-up. There were no significant differences between both groups in terms of P wave duration [PWD] (ESUS vs. AF, P=0.321). PWD demonstrated a significant predictive efficacy for SCAF detection during follow-up (C-index of standard PWD=0.657, 95% confidence interval (CI) 0.552–0.761, P=0.008). Stroke recurrence occurred in 22 patients (17.6%) and was significantly associated with PWD but not SCAF (odds ratio 2.756, 95% CI 1.061–7.161, P=0.037). Conclusion PWD, an ECG biomarker associated with atrial substrate directly contributes to AF and ESUS, is useful for predicting SCAF. The potential for using this simple ECG biomarker for screening for SCAF amongst ESUS patients merits further exploration.

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Abstract 197: Do the CHADS 2 , CHA 2 DS 2 -VASc and HAS-BLED Scores Predict Recurrent Stroke and GI Bleeding in Patients with Acute Ischemic Stroke or TIA and Atrial Fibrillation?

Stroke ◽

10.1161/str.44.suppl_1.a197 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Frank L Silver ◽

Melissa Stamplecoski ◽

Jiming Fang ◽

Moira K Kapral

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Acute Stroke ◽

Major Bleeding ◽

Hemorrhagic Stroke ◽

Hospital Admissions ◽

Recurrent Stroke ◽

Simple Random Sample ◽

Major Hemorrhage ◽

One Year

Background: In patients with atrial fibrillation (AF) the CHADS 2 and CHA 2 DS 2 -VASc score are used to provide a risk for subsequent stroke and the HAS-BLED score for hemorrhage. These scores were derived from large cohorts of patients with AF, however, only 8 - 25% of the patients had a past history of stroke. We wanted to determine whether these prediction scores had utility in patients with AF who have had a recent stroke or TIA. Methods: We selected patients with AF and a first stroke or TIA from the 2002-3, 2004-5, 2008-9 and 2010-11 Ontario Stroke Audits (OSA). The OSA includes data from a simple random sample of 15 - 20% of stroke and TIA patients presenting to all Ontario hospitals identified using ICD-10 diagnostic codes I60, I61, I63, I64, H34.1 and G45. Recurrent ischemic stroke, hemorrhagic stroke and major GI hemorrhage were obtained by linking the OSA data to administrative databases for hospital admissions in the subsequent year. Results: There were 3,960 patients with AF in the OSA who were discharged alive following their first acute stroke or TIA. The median age was 80. At discharge 41% of the patients were prescribed anticoagulants, 24% antiplatelet therapy, 25% both and 9% were prescribed no antithrombotic therapy. The one year readmission rate for stroke was 5.3% (including 0.4% hemorrhagic stroke) and 1.9% for major hemorrhage. Multivariable logistic regression models did not show any significant association between the CHADS 2 and CHA 2 DS 2 -VASc scores and the risk of recurrent stroke. The HAS-BLED score failed to predict hemorrhagic stroke or major bleeding and the risk of major bleeding for the entire group at one year was low (1.9%). Patients prescribed anticoagulants at discharge had fewer recurrent strokes (OR 0.55; 95% CI 0.34 - 0.90, p=0.02), a lower one year mortality (OR 0.42; 95% CI 0.31 - 0.56, p <0.001) and the same risk of major bleeding as compared to patients not receiving anticoagulants. Conclusions: The CHADS 2 , CHA 2 DS 2 -VASc and HAS-BLED scores did not predict recurrent stroke or hemorrhage in patients following an acute stroke or TIA. Anticoagulation at discharge was associated with a lower risk of recurrent stroke and death without a significant increase in the risk of major hemorrhage.

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