Early recurrence and major bleeding in patients with acute ischemic stroke and atrial fibrillation treated with non-vitamin-K oral anticoagulants (RAF-NOACs) study

Paciaroni, M. et al. (2017) Early recurrence and major bleeding in patients with acute ischemic stroke and atrial fibrillation treated with non-vitamin-K oral anticoagulants (RAF-NOACs) study. Journal of the American Heart Association, 6(12), e007034. (doi: 10.1161/JAHA.117.007034) (PMID:29220330) (PMCID:PMC5779022)

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.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Abdul-Rahim, Dr Azmil and Lees, Professor Kennedy
• Authors: Paciaroni, M., Agnelli, G., Falocci, N., Tsivgoulis, G., Vadikolias, K., Liantinioti, C., Chondrogianni, M., Bovi, P., Carletti, M., Cappellari, M., Zedde, M., Ntaios, G., Karagkiozi, E., Athanasakis, G., Makaritsis, K., Silvestrelli, G., Lanari, A., Ciccone, A., Putaala, J., Tomppo, L., Tatlisumak, T., Abdul-Rahim, A. H., Lees, K. R., Alberti, A., Venti, M., Acciarresi, M., D'Amore, C., Becattini, C., Mosconi, M. G., Cimini, L. A., Soloperto, R., Masotti, L., Vannucchi, V., Lorenzini, G., Tassi, R., Guideri, F., Acampa, M., Martini, G., Sohn, S.-I., Marcheselli, S., Mumoli, N., De Lodovici, M. L., Bono, G., Furie, K. L., Tadi, P., Yaghi, S., Toni, D., Letteri, F., Tassinari, T., Kargiotis, O., Lotti, E. M., Flomin, Y., Mancuso, M., Maccarrone, M., Giannini, N., Bandini, F., Pezzini, A., Poli, L., Padovani, A., Scoditti, U., Denti, L., Consoli, D., Galati, F., Sacco, S., Carolei, A., Tiseo, C., Gourbali, V., Orlandi, G., Giuntini, M., Chiti, A., Giorli, E., Gialdini, G., Corea, F., Ageno, W., Bellesini, M., Colombo, G., Monaco, S., Baronello, M. M., Karapanayiotides, T., 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
• Journal Name: Journal of the American Heart Association
• Publisher: American Heart Association
• ISSN: 2047-9980
• ISSN (Online): 2047-9980
• Published Online: 29 November 2017
• Copyright Holders: Copyright © 2017 The Authors
• First Published: First published in Journal of the American Heart Association 6(12): e007034
• Publisher Policy: Reproduced under a Creative Commons License