DIRECE ORAL ANTICOAGULANT REDUCES STROKE SEVERITY IN PATIENTS WITH ACUTE ISCHEMIC STROKE AND NON-VALVULAR ATRIAL FIBRILLATION

2017 ◽  
Author(s):  
Yuki Sakamoto
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Oral Anticoagulant ◽  
Stroke Severity

Abstract TP416: Comparative Effectiveness of Addition of Antiplatelet to Oral Anticoagulant in Acute Ischemic Stroke With Atrial Fibrillation

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Joon-tae Kim ◽  
Hee-Joon Bae ◽  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Oral Anticoagulant ◽  
Recurrent Stroke ◽  
Cox Proportional Hazards ◽  
Large Artery ◽  
Vascular Events ◽  
Nihss Score ◽  
Composite Events

Introduction: Atrial fibrillation (AF) and large artery diseases (LAD) share several risk factors and often coexist in the same patient. Optimal treatments for acute ischemic stroke (AIS) patients with concomitant AF and LAD have not been extensively studied so far. Objective: This study aimed to compare the effectiveness of the addition of antiplatelet (AP) to oral anticoagulant (OAC) with that of OAC alone in AIS with AF according to the LAD. Methods: Using a multicenter stroke registry, acute (within 48h of onset) and mild-to-moderate (NIHSS score ≤15) stroke patients with AF were identified. Propensity scores using IPTW were used to adjust baseline imbalances between the OAC+AP group and the OAC alone group in all patients and in each subgroup by LAD. The primary outcome was major vascular events, defined as the composite of recurrent stroke, MI, and all-cause mortality at up to 3 months after index stroke. Results: Among the 5469 patients (age, 72±10yrs; male, 54.9%; initial NIHSS score, 4 [2-9]), 79.0% (n=4323) received OAC alone, and 21.0% (n=1146) received OAC+AP. By weighted Cox proportional hazards analysis, a tendency of increasing the risk of 3-months primary composite events in the OAC+AP group vs the OAC alone (HR 1.36 [0.99-1.87], p=0.06), with significant interaction with treatments and LAD (Pint=0.048). Briefly, among patients with moderate-to-severe large artery stenosis, tendency of decrease in 3-months primary composite events of the OAC+AP group, compared with OAC alone group, was observed (HR 0.54 [0.17-1.70]), whereas among patients with complete occlusion, the OAC+AP group markedly increased the risk of 3-months composite events (HR 2.00 [1.27-3.15]), compared with the OAC alone group. No interaction between direct oral anticoagulant and warfarin on outcome was observed (Pint=0.35). Conclusion: In conclusion, treatment with addition of AP to OAC had a tendency to increase the risk of 3-months vascular events, compared with OAC alone in AIS with AF. However, the effects of antithrombotic treatment could be modified according to the LAD, with substantial benefits of OAC alone in subgroup of large artery occlusion. Our results address the need for the further study to tailor the optimal treatment in AIS with concomitant AF and LAD.

scholarly journals Mechanical thrombextraction in patient with acute ischemic stroke on background of oral anticoagulant therapy

2021 ◽  
pp. 36-40
Author(s):  
V.О. Yarosh ◽  
◽  
V.V. Babenko ◽  
O.E. Svyrydiuk ◽  
O.J. Zharinov ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Acute Ischemic Stroke ◽  
Anticoagulant Therapy ◽  
Oral Anticoagulant ◽  
Oral Anticoagulant Therapy ◽  
Interventional Treatment ◽  
Key Words Ischemic Stroke

Thrombolytic therapy, which is a priority treatment strategy in patients with acute ischemic stroke in the first 3-4.5 hours after start of the disease, has significant limitations in case of background anticoagulant therapy. Mechanic thrombextraction is considered to be an alternative therapeutic strategy in case of inefficacy or contraindications to thrombolytic therapy. The article presents a clinical case of the 75-year old female patient with acute cardioembolic stroke on background of heart failure and atrial fibrillation. Long-term background usage of the direct oral anticoagulant due to atrial fibrillation is a limitation to use thrombolytic therapy, therefore mechanical thrombextraction was performed. The case presents possibilities of the successful interventional treatment of acute cardioembolic ischemic stroke. An example of a possible drug-drug interaction possibly leading to reduction of the effectiveness of anticoagulant therapy is shown. Key words: ischemic stroke, anticoagulants, mechanical trombextraction.

scholarly journals Effect of Atrial Fibrillation on Acute Ischemic Stroke Severity

2014 ◽  
Vol 04 (02) ◽  
pp. 95-101
Author(s):  
Taha Kamel Alloush ◽  
Mahmoud Haroun Ibrahim ◽  
Nahed Salah El Dein Ahmed Ibrahim ◽  
Ghada Samir El-Shahed ◽  
Lobna Mohamed Nabil El-Sayed ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Severity

scholarly journals Optimal timing of anticoagulation after acute ischemic stroke with atrial fibrillation (OPTIMAS): Protocol for a randomized controlled trial

2022 ◽  
pp. 174749302110577
Author(s):  
Jonathan G Best ◽  
Liz Arram ◽  
Norin Ahmed ◽  
Maryam Balogun ◽  
Kate Bennett ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intracranial Hemorrhage ◽  
Oral Anticoagulant ◽  
Controlled Trial ◽  
Optimal Timing ◽  
Direct Oral Anticoagulant ◽  
Randomized Controlled ◽  
Delayed Initiation

Rationale Atrial fibrillation causes one-fifth of ischemic strokes, with a high risk of early recurrence. Although long-term anticoagulation is highly effective for stroke prevention in atrial fibrillation, initiation after stroke is usually delayed by concerns over intracranial hemorrhage risk. Direct oral anticoagulants offer a significantly lower risk of intracranial hemorrhage than other anticoagulants, potentially allowing earlier anticoagulation and prevention of recurrence, but the safety and efficacy of this approach has not been established. Aim Optimal timing of anticoagulation after acute ischemic stroke with atrial fibrillation (OPTIMAS) will investigate whether early treatment with a direct oral anticoagulant, within four days of stroke onset, is as effective or better than delayed initiation, 7 to 14 days from onset, in atrial fibrillation patients with acute ischemic stroke. Methods and design OPTIMAS is a multicenter randomized controlled trial with blinded outcome adjudication. Participants with acute ischemic stroke and atrial fibrillation eligible for anticoagulation with a direct oral anticoagulant are randomized 1:1 to early or delayed initiation. As of December 2021, 88 centers in the United Kingdom have opened. Study outcomes The primary outcome is a composite of recurrent stroke (ischemic stroke or symptomatic intracranial hemorrhage) and systemic arterial embolism within 90 days. Secondary outcomes include major bleeding, functional status, anticoagulant adherence, quality of life, health and social care resource use, and length of hospital stay. Sample size target A total of 3478 participants assuming event rates of 11.5% in the control arm and 8% in the intervention arm, 90% power and 5% alpha. We will follow a non-inferiority gatekeeper analysis approach with a non-inferiority margin of 2 percentage points. Discussion OPTIMAS aims to provide high-quality evidence on the safety and efficacy of early direct oral anticoagulant initiation after atrial fibrillation-associated ischemic stroke. Trial registrations: ISRCTN: 17896007; ClinicalTrials.gov: NCT03759938

Abstract TP429: Early Oral Anticoagulation After Acute Ischemic Stroke in Patients With Atrial Fibrillation

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Andrew B Buletko ◽  
Rejo P Cherian ◽  
Christine Ahrens ◽  
Ken Uchino ◽  
Andrew Russman
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Oral Anticoagulation ◽  
Infarct Volume ◽  
Cleveland Clinic ◽  
Early Initiation ◽  
Stroke Severity ◽  
Major Hemorrhage

Introduction: Uncertainty exists as to the optimum interval for initiation of oral anticoagulation (OAC) after an acute ischemic stroke (AIS) in patients with atrial fibrillation (AF). Randomized clinical trials of novel oral anticoagulants excluded patients with AIS within 7-14 days. We sought to identify patients at low risk for early initiation of OAC after AIS. Hypothesis: The benefit of starting OAC within 2 days to prevent recurrent AIS outweighs the risk of hemorrhagic transformation (HT) in select patients. Methods: Following IRB approval, we completed a retrospective review of patients from the Cleveland Clinic from 2012-2014 with AIS, AF, and at least 1 follow up visit. In addition to demographic and medical history, acute infarct volume on imaging, presence of HT on imaging prior to OAC, timing and type of oral anticoagulation, and ischemic and hemorrhagic complications were noted. Early OAC was defined as starting within 48 hours after stroke onset, and late OAC was thereafter. The two groups were compared using Fisher’s exact test for categorical and Wilcoxon Rank Sum for numeric variables. Results: One hundred patients (median age 76, interquartile range 66-84) met our study criteria. Thirty-one patients were started on OAC within 2 days vs 53 patients after 2 days (median 1 days vs median 11 days). Compared to patients started on OAC after 2 days, those who initiated OAC within 2 days had significantly lower infarct volume (median 3.35 ml vs median 9.8 ml; p<0.0001), initial NIHSS (median 3 vs median 7; p <0.0001), and fewer people with blood on brain imaging (3% vs 26%; p= 0.0074). Age, prior stroke, and choice of OAC were not significantly associated with timing of OAC. No patients had recurrent AIS or symptomatic HT at median follow-up observation of 37 days. One patient had a non-CNS major hemorrhage after starting OAC. Sixteen patients were not started on OAC for a variety of reasons. Conclusions: Our results suggest the safety of early initiation of OAC with 2 days in an appropriately selected population of patients with AIS, who have small infarct volumes, mild stroke severity, and lack of HT.

Association of Preceding Antithrombotic Treatment With Acute Ischemic Stroke Severity and In-Hospital Outcomes Among Patients With Atrial Fibrillation

JAMA ◽  
2017 ◽  
Vol 317 (10) ◽  
pp. 1057 ◽  
Author(s):  
Ying Xian ◽  
Emily C. O’Brien ◽  
Li Liang ◽  
Haolin Xu ◽  
Lee H. Schwamm ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Severity ◽  
Antithrombotic Treatment ◽  
Hospital Outcomes

scholarly journals Initiation of Guideline-Matched Oral Anticoagulant in Atrial Fibrillation-Related Stroke

2021 ◽  
Vol 23 (1) ◽  
pp. 113-123
Author(s):  
Mi-Yeon Eun ◽  
Jae-Young Kim ◽  
Yang-Ha Hwang ◽  
Man-Seok Park ◽  
Joon-Tae Kim ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Anticoagulant Therapy ◽  
Oral Anticoagulant ◽  
Oral Anticoagulant Therapy ◽  
Bleeding Complications ◽  
Major Hemorrhage ◽  
Matched Group ◽  
Secondary Outcomes

Background and Purpose To evaluate the outcome events and bleeding complications of the European Society of Cardiology (ESC) guideline-matched oral anticoagulant therapy for patients with acute ischemic stroke and atrial fibrillation (AF).Methods Patients with acute ischemic stroke and AF from a nationwide multicenter registry (Korean ATrial fibrillaTion EvaluatioN regisTry in Ischemic strOke patieNts [K-ATTENTION]) between January 2013 and December 2015 were included in the study. Patients were divided into the ESC guideline-matched and the non-matched groups. The primary outcome was recurrence of any stroke during the 90-day follow-up period. Secondary outcomes were major adverse cerebrovascular and cardiovascular events, ischemic stroke, intracranial hemorrhage, acute coronary syndrome, allcause mortality, and major hemorrhage. Propensity score matching and logistic regression analyses were performed to assess the effect of the treatments administered.Results Among 2,321 eligible patients, 1,126 patients were 1:1 matched to the ESC guidelinematched and the non-matched groups. As compared with the non-matched group, the ESC guideline-matched group had a lower risk of any recurrent stroke (1.4% vs. 3.4%; odds ratio [OR], 0.41; 95% confidence interval [CI], 0.18 to 0.95). The risk of recurrent ischemic stroke was lower in the ESC guideline-matched group than in the non-matched group (0.9% vs. 2.7%; OR, 0.32; 95% CI, 0.11 to 0.88). There was no significant difference in the other secondary outcomes between the two groups.Conclusions ESC guideline-matched oral anticoagulant therapy was associated with reduced risks of any stroke and ischemic stroke as compared with the non-matched therapy.

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