EARLY VERSUS LATE INITIATION OF DIRECT ORAL ANTICOAGULATION IN POST-ISCHAEMIC STROKE PATIENTS WITH ATRIAL FIBRILLATION (ELAN)

SummaryIn patients with acute stroke and atrial fibrillation (AF), the risk of early recurrence has been reported to range between 0.1% and 1.3% per day. Anticoagulants are the most effective therapy for the prevention of recurrent ischaemic stroke in these patients, but randomised clinical trials have failed to produce any evidence supporting the administration of heparin within 48 hours from stroke onset as it has been associated with a non-significant reduction in the recurrence of ischaemic stroke, no substantial reduction in death and disability, and an increase in intracranial bleeding. As early haemorrhagic transformation is a major concern in the acute phase of stroke patients with AF, determining the optimal time to start anticoagulant therapy is essential. This review which focuses on the epidemiology of recurrent ischaemic stroke and haemorrhagic transformation in patients with acute ischaemic stroke and AF, proposes a model for decision making on optimal timing for initiating anticoagulation, based on currently available evidence.

Download Full-text

Association of improved outcome in acute ischaemic stroke patients with atrial fibrillation who receive early antithrombotic therapy: analysis from VISTA

European Journal of Neurology ◽

10.1111/ene.12577 ◽

2014 ◽

Vol 22 (7) ◽

pp. 1048-1055 ◽

Cited By ~ 40

Author(s):

A. H. Abdul-Rahim ◽

R. L. Fulton ◽

B. Frank ◽

T. Tatlisumak ◽

M. Paciaroni ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischaemic Stroke ◽

Acute Ischaemic Stroke ◽

Antithrombotic Therapy ◽

Stroke Patients ◽

Improved Outcome

Download Full-text

Temporal Trends and Patient Characteristics Associated With Drug Utilisation After First-Ever Stroke: Insights From Chronic Disease Registry Data in Singapore

Annals of the Academy of Medicine, Singapore ◽

10.47102/annals-acadmedsg.2019196 ◽

2020 ◽

Vol 49 (3) ◽

pp. 137-154

Author(s):

See-Hwee Yeo ◽

Matthias Paul HS Toh ◽

Sze Haur Lee ◽

Raymond CS Seet ◽

Lai Yin Wong ◽

...

Keyword(s):

Atrial Fibrillation ◽

Chronic Disease ◽

Ischaemic Stroke ◽

Drug Utilisation ◽

Temporal Trends ◽

Patient Characteristics ◽

Haemorrhagic Stroke ◽

Stroke Patients ◽

Thrombolytic Agents ◽

Combined Use

Introduction: Data on drug utilisation among stroke patients of Asian ethnicities are lacking. The objectives of the study were to examine the temporal trends and patient characteristics associated with prescription of thrombolytic, antithrombotic and statin medications among patients with first-ever stroke. Materials and Methods: First-ever ischaemic and haemorrhagic stroke patients admitted to 2 Singapore tertiary hospitals between 2010‒2014 were included. Data were extracted from the National Healthcare Group Chronic Disease Management System. Association between drug utilisation and admission year, as well as characteristics associated with drug use, were explored using multivariable logistic regression. Results: There was an increasing trend in the combined use of all 3 guideline medications in ischaemic stroke patients (P<0.001) ―specifically thrombolytic agents (P <0.001), oral antithrombotics (P = 0.002) and statins (P = 0.003) at discharge. Among antithrombotics, the use of clopidogrel (P <0.001) and aspirinclopidogrel (P <0.001) had increased, whereas prescription of dipyridamole (P <0.001) and aspirin-dipyridamole (P <0.001) had declined. For statins, the increase in atorvastatin prescription (P <0.001) was accompanied by decreasing use of simvastatin (P <0.001). Age, ethnicity and certain comorbidities (hyperlipidaemia, atrial fibrillation and chronic kidney disease) were associated with the combined use of all 3 guideline medications (P <0.05). In haemorrhagic stroke, prescription of statins at discharge were comparatively lower. Conclusion: This study reveals changes in prescription behaviour over time in a multiethnic Asian population with first-ever stroke. Patient characteristics including younger age, Malay ethnicity and certain comorbidities (i.e. hyperlipidaemia, atrial fibrillation) were associated with the combined use of all 3 guideline medications among ischaemic stroke patients. Key words: Antithrombotics, Asian, Statins, Thrombolytic agents

Download Full-text

Adherence to oral anticoagulation in ischemic stroke patients with atrial fibrillation

Annals of Medicine ◽

10.1080/07853890.2021.1968031 ◽

2021 ◽

Vol 53 (1) ◽

pp. 1613-1620

Author(s):

Paula Tiili ◽

Ioannis Leventis ◽

Janne Kinnunen ◽

Ida Svedjebäck ◽

Mika Lehto ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Oral Anticoagulation ◽

Stroke Patients

Download Full-text

Oral anticoagulation in patients with atrial fibrillation and acute ischaemic stroke: design and baseline data of the prospective multicentre Berlin Atrial Fibrillation Registry

EP Europace ◽

10.1093/europace/euz199 ◽

2019 ◽

Vol 21 (11) ◽

pp. 1621-1632 ◽

Cited By ~ 3

Author(s):

Karl Georg Haeusler ◽

Serdar Tütüncü ◽

Claudia Kunze ◽

Johannes Schurig ◽

Carolin Malsch ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischaemic Stroke ◽

Hospital Discharge ◽

Vitamin K ◽

Acute Ischaemic Stroke ◽

Oral Anticoagulation ◽

Endovascular Thrombectomy ◽

Stroke Units ◽

Ischaemic Attack

Abstract Aims The Berlin Atrial Fibrillation Registry was designed to analyse oral anticoagulation (OAC) prescription in patients with atrial fibrillation (AF) and acute ischaemic stroke. Methods and results This investigator-initiated prospective multicentre registry enrolled patients at all 16 stroke units located in Berlin, Germany. The ongoing telephone follow-up is conducted centrally and will cover 5 years per patient. Within 2014 and 2016, 1080 patients gave written informed consent and 1048 patients were available for analysis. Median age was 77 years [interquartile range (IQR) 72–83], 503 (48%) patients were female, and 254 (24%) had a transient ischaemic attack (TIA). Overall, 470 (62%) out of 757 patients with known AF and a (pre-stroke) CHA2DS2-VASc ≥ 1 were anticoagulated at the time of stroke. At hospital discharge, 847 (81.3%) of 1042 patients were anticoagulated. Thereof 710 (68.1%) received a non-vitamin K-dependent oral anticoagulant (NOAC) and 137 (13.1%) a vitamin K antagonist (VKA). Pre-stroke intake of a NOAC [odds ratio (OR) 15.6 (95% confidence interval, 95% CI 1.97–122)] or VKA [OR 0.04 (95% CI 0.02–0.09)], an index TIA [OR 0.56 (95% CI 0.34–0.94)] rather than stroke, heart failure [OR 0.49 (95% CI 0.26–0.93)], and endovascular thrombectomy at hospital admission [OR 12.9 (95% CI 1.59–104)] were associated with NOAC prescription at discharge. Patients’ age or AF type had no impact on OAC or NOAC use, respectively. Conclusion About 60% of all registry patients with known AF received OAC at the time of stroke or TIA. At hospital discharge, more than 80% of AF patients were anticoagulated and about 80% of those were prescribed a NOAC.

Download Full-text