Format

Send to

Choose Destination
J Am Heart Assoc. 2017 Nov 29;6(12). pii: e007034. doi: 10.1161/JAHA.117.007034.

Early Recurrence and Major Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation Treated With Non-Vitamin-K Oral Anticoagulants (RAF-NOACs) Study.

Author information

1
Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy maurizio.paciaroni@unipg.it.
2
Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy.
3
Second Department of Neurology, National & Kapodistrian University of Athens School of Medicine, "Attikon" University Hospital, Athens, Greece.
4
Department of Neurology, Democritus University of Thrace University Hospital of Alexandroupolis, Greece.
5
SSO Stroke Unit, UO Neurologia, DAI di Neuroscienze, AOUI Verona, Verona, Italy.
6
Neurology Unit, Stroke Unit, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy.
7
Department of Medicine, University of Thessaly, Larissa, Greece.
8
S.C. di Neurologia e S.S. di Stroke Unit, ASST di Mantova, Mantova, Italy.
9
Department of Neurology, Helsinki University Hospital, Helsinki, Finland.
10
Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden.
11
Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
12
Medical School and Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom.
13
Internal Medicine, Santa Maria Nuova Hospital, Firenze, Italy.
14
Stroke Unit, AOU Senese, Siena, Italy.
15
Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea.
16
Neurologia d'urgenza e Stroke Unit, Istituto Clinico Humanitas, Rozzano Milano, Italy.
17
Department of Internal Medicine, Ospedale Civile di Livorno, Livorno, Italy.
18
Stroke Unit, Neurology, Insubria University, Varese, Italy.
19
Division of Stroke and Cerebrovascular Diseases, Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI.
20
Department of Neurology and Psychiatry, Sapienza University of Rome, Italy.
21
Stroke Unit-Department of Neurology, Santa Corona Hospital, Pietra Ligure (Savona), Italy.
22
Stroke Unit Metropolitan Hospital, Piraeus, Greece.
23
U.O. Neurologia Presidio Ospedaliero di Ravenna Azienda USL della Romagna, Ravenna, Italy.
24
Stroke and Neurorehabilitation Unit MC 'Universal Clinic 'Oberig', Kyiv, Ukraine.
25
Clinica Neurologica - Azienda Ospedaliero-Universitaria, Pisa, Italy.
26
Department of Neurology, Ospedale San Paolo, Savona, Italy.
27
Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Italy.
28
Stroke Unit, Neuroscience Department, University of Parma, Italy.
29
Stroke Unit, Dipartimento Geriatrico Riabilitativo, University of Parma, Italy.
30
Stroke Unit, Jazzolino Hospital, Vibo Valentia, Italy.
31
Department of Neurology, Avezzano Hospital, University of L'Aquila, Italy.
32
Department of Neurology, Evangelismos Hospital, Athens, Greece.
33
Neurologia, Ospedale Apuano, Massa Carrara, Italy.
34
Stroke Unit, Department of Neurology, Sant'Andrea Hospital, La Spezia, Italy.
35
UO Gravi Cerebrolesioni, San Giovanni Battista Hospital, Foligno, Italy.
36
Department of Internal Medicine, Insubria University, Varese, Italy.
37
Stroke Unit Ospedale Civico, Palermo, Italy.
38
2 Department of Neurology, AHEPA University Hospital, Thessaloniki, Greece.

Abstract

BACKGROUND:

The optimal timing to administer non-vitamin K oral anticoagulants (NOACs) in patients with acute ischemic stroke and atrial fibrillation is unclear. This prospective observational multicenter study evaluated the rates of early recurrence and major bleeding (within 90 days) and their timing in patients with acute ischemic stroke and atrial fibrillation who received NOACs for secondary prevention.

METHODS AND RESULTS:

Recurrence was defined as the composite of ischemic stroke, transient ischemic attack, and symptomatic systemic embolism, and major bleeding was defined as symptomatic cerebral and major extracranial bleeding. For the analysis, 1127 patients were eligible: 381 (33.8%) were treated with dabigatran, 366 (32.5%) with rivaroxaban, and 380 (33.7%) with apixaban. Patients who received dabigatran were younger and had lower admission National Institutes of Health Stroke Scale score and less commonly had a CHA2DS2-VASc score >4 and less reduced renal function. Thirty-two patients (2.8%) had early recurrence, and 27 (2.4%) had major bleeding. The rates of early recurrence and major bleeding were, respectively, 1.8% and 0.5% in patients receiving dabigatran, 1.6% and 2.5% in those receiving rivaroxaban, and 4.0% and 2.9% in those receiving apixaban. Patients who initiated NOACs within 2 days after acute stroke had a composite rate of recurrence and major bleeding of 12.4%; composite rates were 2.1% for those who initiated NOACs between 3 and 14 days and 9.1% for those who initiated >14 days after acute stroke.

CONCLUSIONS:

In patients with acute ischemic stroke and atrial fibrillation, treatment with NOACs was associated with a combined 5% rate of ischemic embolic recurrence and severe bleeding within 90 days.

KEYWORDS:

acute stroke; anticoagulants; atrial fibrillation; secondary prevention

PMID:
29220330
PMCID:
PMC5779022
DOI:
10.1161/JAHA.117.007034
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Atypon Icon for PubMed Central
Loading ...
Support Center