Timing of initiation of oral anticoagulants in patients with acute ischemic stroke and atrial fibrillation comparing posterior and anterior circulation strokes

Paciaroni, M. et al. (2020) Timing of initiation of oral anticoagulants in patients with acute ischemic stroke and atrial fibrillation comparing posterior and anterior circulation strokes. European Stroke Journal, 5(4), pp. 374-383. (doi: 10.1177/2396987320937116)

Abstract

Background: The aim of this study in patients with acute posterior ischemic stroke (PS) and atrial fibrillation (AF) were to evaluate the risks of recurrent ischemic event and severe bleeding and these risks in relation with oral anticoagulant therapy (OAT) and its timing. Methods: Patients with PS were prospectively included; the outcome events of these patients were compared with those of patients with anterior stroke (AS) which were taken from previous registries. The primary outcome was the composite of: stroke recurrence, TIA, symptomatic systemic embolism, symptomatic cerebral bleeding and major extracranial bleeding occurring within 90 days from acute stroke. Results: A total of 2,470 patients were available for the analysis: 473 (19.1%) with PS and 1,997 (80.9%) AS. Over 90 days, 213 (8.6%) primary outcome events were recorded: 175 (8.7%) in patients with AS and 38 (8.0%) in those with PS. In patients who initiated OAT within 2 days, the primary outcome occurred in 5 out of 95 patients (5.3%) with PS compared to 21 out of 373 patients (4.3%) with AS (OR 1.07; 95% CI 0.39-2.94). In patients who initiated OAT between days 3 and 7, the primary outcome occurred in 3 out of 103 patients (2.9%) with PS compared to 26 out of 490 patients (5.3%) with AS (OR 0.54; 95% CI 0.16-1.80). Conclusions: Patients with posterior or anterior stroke and AF appear to have similar risks of ischemic or hemorrhagic events at 90 days with no difference concerning the timing of initiation of OAT.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Abdul-Rahim, Dr Azmil and Lees, Professor Kennedy and Dawson, Professor Jesse
• Authors: Paciaroni, M., Agnelli, G., Giustozzi, M., Tsivgoulis, G., Yaghi, S., MacGrory, B., Furie, K. L., Tadi, P., Zedde, M., Abdul-Rahim, A. H., Dawson, J., Lees, K. R., Alberti, A., Venti, M., Acciarresi, M., D'Amore, C., Mosconi, M. G., Bognini, V., Cappellari, M., Rigatelli, A., Bonetti, B., Putaala, J., Tomppo, L., Tatlisumak, T., Bandini, F., Marcheselli, S., Pezzini, A., Poli, L., Padovani, A., Masotti, L., Grifoni, E., Vannucchi, V., Sohn, S.-I., Lorenzini, G., Tassi, R., Guideri, F., Acampa, M., Martini, G., Ntaios, G., Athanasakis, G., Makaritsis, K., Karagkiozi, E., Vadikolias, K., Liantinioti, C., Palaiodimou, L., Mumoli, N., Porta, C., Galati, F., Sacco, S., Tiseo, C., Corea, F., Ageno, W., Bellesini, M., Silvestrelli, G., Ciccone, A., Scoditti, U., Denti, L., Mancuso, M., Caselli, M. C., Maccarrone, M., Ulivi, L., Orlandi, G., Giannini, N., Tassinari, T., De Lodovici, M. L., Rueckert, C., Baldi, A., Toni, D., Gentile, L., Letteri, F., Giuntini, M., Lotti, E. M., Flomin, Y., Pieroni, A., Kargiotis, O., Karapanayiotides, T., Monaco, S., Mannino, M., Maimone Baronello, M., Csiba, L., Szabó, L., Chiti, A., Giorli, E., Del Sette, M., Schirinzi, E., Imberti, D., Zabzuni, D., Doronin, B., Volodina, V., Michel, P., Eskandari, A., Vanacker, P., Barlinn, K., Barlinn, J., Deleu, D., Gourbali, V., and Caso, V.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Psychology & Neuroscience; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: European Stroke Journal
• Publisher: SAGE Publications
• ISSN: 2396-9873
• ISSN (Online): 2396-9881
• Published Online: 22 July 2020
• Copyright Holders: Copyright © 2020 The Authors
• First Published: First published in European Stroke Journal 5(4):374-383
• Publisher Policy: Reproduced in accordance with the publisher copyright policy