Causes and risk factors of cerebral ischemic events in patients with atrial fibrillation treated with non–vitamin K antagonist oral anticoagulants for stroke prevention

Paciaroni, M. et al. (2019) Causes and risk factors of cerebral ischemic events in patients with atrial fibrillation treated with non–vitamin K antagonist oral anticoagulants for stroke prevention. Stroke, 50(8), pp. 2168-2174. (doi: 10.1161/strokeaha.119.025350) (PMID:31234756)

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Abstract

Background and Purpose: Despite treatment with oral anticoagulants, patients with nonvalvular atrial fibrillation (AF) may experience ischemic cerebrovascular events. The aims of this case-control study in patients with AF were to identify the pathogenesis of and the risk factors for cerebrovascular ischemic events occurring during non–vitamin K antagonist oral anticoagulants (NOACs) therapy for stroke prevention. Methods: Cases were consecutive patients with AF who had acute cerebrovascular ischemic events during NOAC treatment. Controls were consecutive patients with AF who did not have cerebrovascular events during NOACs treatment. Results: Overall, 713 cases (641 ischemic strokes and 72 transient ischemic attacks; median age, 80.0 years; interquartile range, 12; median National Institutes of Health Stroke Scale on admission, 6.0; interquartile range, 10) and 700 controls (median age, 72.0 years; interquartile range, 8) were included in the study. Recurrent stroke was classified as cardioembolic in 455 cases (63.9%) according to the A-S-C-O-D (A, atherosclerosis; S, small vessel disease; C, cardiac pathology; O, other causes; D, dissection) classification. On multivariable analysis, off-label low dose of NOACs (odds ratio [OR], 3.18; 95% CI, 1.95–5.85), atrial enlargement (OR, 6.64; 95% CI, 4.63–9.52), hyperlipidemia (OR, 2.40; 95% CI, 1.83–3.16), and CHA2DS2-VASc score (OR, 1.72 for each point increase; 95% CI, 1.58–1.88) were associated with ischemic events. Among the CHA2DS2-VASc components, age was older and presence of diabetes mellitus, congestive heart failure, and history of stroke or transient ischemic attack more common in patients who had acute cerebrovascular ischemic events. Paroxysmal AF was inversely associated with ischemic events (OR, 0.45; 95% CI, 0.33–0.61). Conclusions: In patients with AF treated with NOACs who had a cerebrovascular event, mostly but not exclusively of cardioembolic pathogenesis, off-label low dose, atrial enlargement, hyperlipidemia, and high CHA2DS2-VASc score were associated with increased risk of cerebrovascular events.

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., Caso, V., Silvestrelli, G., Seiffge, D. J., Engelter, S., De Marchis, G. M., Polymeris, A., Zedde, M. L., Yaghi, S., Michel, P., Eskandari, A., Antonenko, K., Sohn, S.-I., Cappellari, M., Tassinari, T., Tassi, R., Masotti, L., Katsanos, A. H., Giannopoulos, S., Acciarresi, M., Alberti, A., Venti, M., Mosconi, M. G., Vedovati, M. C., Pierini, P., Giustozzi, M., Lotti, E. M., Ntaios, G., Kargiotis, O., Monaco, S., Lochner, P., Bandini, F., Liantinioti, C., Palaiodimou, L., Abdul-Rahim, A. H., Lees, K., Mancuso, M., Pantoni, L., Rosa, S., Bertora, P., Galliazzo, S., Ageno, W., Toso, E., Angelini, F., Chiti, A., Orlandi, G., Denti, L., Flomin, Y., Marcheselli, S., Mumoli, N., Rimoldi, A., Verrengia, E., Schirinzi, E., Del Sette, M., Papamichalis, P., Komnos, A., Popovic, N., Zarkov, M., Rocco, A., Diomedi, M., Giorli, E., Ciccone, A., Mac Grory, B. C., Furie, K. L., Bonetti, B., Saia, V., Guideri, F., Acampa, M., Martini, G., Grifoni, E., Padroni, M., Karagkiozi, E., Perlepe, K., Makaritsis, K., Mannino, M., Maccarrone, M., Ulivi, L., Giannini, N., Ferrari, E., Pezzini, A., Doronin, B., Volodina, V., Baldi, A., D’Amore, C., Deleu, D., Corea, F., Putaala, J., Santalucia, P., Nardi, K., Risitano, A., Toni, D., and Tsivgoulis, G.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Stroke
Publisher:American Heart Association
ISSN:0039-2499
ISSN (Online):1524-4628
Published Online:25 June 2019
Copyright Holders:Copyright © 2019 American Heart Association, Inc.
First Published:First published in Stroke 50(8):2168-2174
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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