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

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.

Download Full-text

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.

Download Full-text

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

Cardiac Surgery and Interventional Cardiology ◽

10.31928/2305-3127-2021.1.3640 ◽

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.

Download Full-text