Ischemic Stroke in orally anticoagulated patients with atrial fibrillation
File(s)
Accepted version
Author(s)
D'Anna, Lucio
Filippidis, Filippos
Harvey, kirsten
Korompoki, Eleni
Veltkamp, Roland
Type
Journal Article
Abstract
Background
Ischemic strokes in orally anticoagulated patients pose challenges for acute management and secondary prevention but the characteristics of these strokes are poorly understood. We examined the clinical and imaging features, the presumed underlying etiology and the subsequent antithrombotic management.
Methods
We analyzed a consecutive series of patients enrolled into the EIDASAF study, a single center, observational study of ischemic stroke patients with a diagnosis atrial fibrillation (AF) prior to the index event who had been admitted to the Hyperacute Stroke Unit of Imperial College London between 2010 and 2017. We compared patients with oral anticoagulation therapy prior admission (OACprior) with those without anticoagulation (OACnaive). Brain imaging was analyzed centrally.
Results
763 patients were included in the analysis. 481 (63%) were OACnaive while 282 (37%) were OACprior. Patients with OACprior were younger, more often had a previous history of stroke or transient ischemic attack (TIA), and more often suffered from hypertension and diabetes. In OACnaive, patients, large and deep middle cerebral artery infarcts occurred more often than in OACprior patients. The groups differed significantly in the distribution of competing etiologies underlying their stroke. At discharge, OACprior more frequently were (re)-anticoagulated compared to OACnaive patients. Within the OACprior group, patients with recurrent strokes did not differ from those with a first stroke regarding clinical characteristics and pattern of cerebral infarction but they were less frequently anticoagulated.
Conclusions
Ischemic strokes on OAC represent a significant proportion of AF-related strokes. There is an unmet need to better understand the causes underlying these strokes and to optimize the medical management.
Ischemic strokes in orally anticoagulated patients pose challenges for acute management and secondary prevention but the characteristics of these strokes are poorly understood. We examined the clinical and imaging features, the presumed underlying etiology and the subsequent antithrombotic management.
Methods
We analyzed a consecutive series of patients enrolled into the EIDASAF study, a single center, observational study of ischemic stroke patients with a diagnosis atrial fibrillation (AF) prior to the index event who had been admitted to the Hyperacute Stroke Unit of Imperial College London between 2010 and 2017. We compared patients with oral anticoagulation therapy prior admission (OACprior) with those without anticoagulation (OACnaive). Brain imaging was analyzed centrally.
Results
763 patients were included in the analysis. 481 (63%) were OACnaive while 282 (37%) were OACprior. Patients with OACprior were younger, more often had a previous history of stroke or transient ischemic attack (TIA), and more often suffered from hypertension and diabetes. In OACnaive, patients, large and deep middle cerebral artery infarcts occurred more often than in OACprior patients. The groups differed significantly in the distribution of competing etiologies underlying their stroke. At discharge, OACprior more frequently were (re)-anticoagulated compared to OACnaive patients. Within the OACprior group, patients with recurrent strokes did not differ from those with a first stroke regarding clinical characteristics and pattern of cerebral infarction but they were less frequently anticoagulated.
Conclusions
Ischemic strokes on OAC represent a significant proportion of AF-related strokes. There is an unmet need to better understand the causes underlying these strokes and to optimize the medical management.
Date Issued
2022-03
Date Acceptance
2021-10-30
Citation
Acta Neurologica Scandinavica, 2022, 145 (3), pp.288-296
ISSN
0001-6314
Publisher
John Wiley and Sons
Start Page
288
End Page
296
Journal / Book Title
Acta Neurologica Scandinavica
Volume
145
Issue
3
Copyright Statement
© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. This is the accepted version of the following article: D'Anna, L, Filippidis, FT, Harvey, K, Korompoki, E, Veltkamp, R. Ischemic stroke in oral anticoagulated patients with atrial fibrillation. Acta Neurol Scand. 2021; 00: 1– 9, which has been published in final form at https://doi.org/10.1111/ane.13552
Identifier
https://onlinelibrary.wiley.com/doi/10.1111/ane.13552
Subjects
Science & Technology
Life Sciences & Biomedicine
Clinical Neurology
Neurosciences & Neurology
anticoagulation
atrial fibrillation
DOAC
ischemic stroke
VKA
DABIGATRAN
WARFARIN
SAFETY
CLASSIFICATION
RIVAROXABAN
PREVENTION
GUIDELINES
MANAGEMENT
SEVERITY
APIXABAN
DOAC
VKA
anticoagulation
atrial fibrillation
ischemic stroke
Anticoagulants
Atrial Fibrillation
Brain Ischemia
Humans
Ischemic Attack, Transient
Ischemic Stroke
Risk Factors
Stroke
Humans
Brain Ischemia
Ischemic Attack, Transient
Atrial Fibrillation
Anticoagulants
Risk Factors
Stroke
Ischemic Stroke
1103 Clinical Sciences
Neurology & Neurosurgery
Publication Status
Published
Date Publish Online
2021-11-12