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  • Benz, Alexander P.McMaster Univ, Populat Hlth Res Inst, 237 Barton St E, Hamilton, ON L8L 2X2, Canada.;Johannes Gutenberg Univ Mainz, Univ Med Ctr Mainz, Dept Cardiol, Langenbeckstr 1, D-55131 Mainz, Rhineland Palat, Germany (author)

Outcomes of patients with atrial fibrillation and ischemic stroke while on oral anticoagulation

  • Article/chapterEnglish2023

Publisher, publication year, extent ...

  • Oxford University Press,2023
  • printrdacarrier

Numbers

  • LIBRIS-ID:oai:DiVA.org:uu-511400
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-511400URI
  • https://doi.org/10.1093/eurheartj/ehad200DOI

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  • Language:English
  • Summary in:English

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  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

Notes

  • Aims The prognosis of patients with atrial fibrillation (AF) and ischemic stroke while taking oral anticoagulation is poorly understood. This study aimed to characterize the outcomes of patients following a stroke event while on oral anticoagulation.Methods and results Individual participant data from five pivotal randomized trials of antithrombotic therapy in AF were used to assess the outcomes of patients with a post-randomization ischemic stroke while on study medication (warfarin, standard-, or lower-dose direct oral anticoagulant regimen) during trial follow-up. The primary outcome was recurrent ischemic stroke after the first post-randomization ischemic stroke. The primary analysis included 1163 patients with a first post-randomization ischemic stroke while on study medication (median age 73 years, 39.3% female, 35.4% history of stroke before trial enrollment). During a median continued follow-up of 337 days, 74 patients had a recurrent ischemic stroke [cumulative incidence at 1 year: 7.0%, 95% confidence interval (CI) 5.2%-8.7%]. The cumulative incidence of mortality at 3 months after stroke was 12.4% (95% CI 10.5%-14.4%). Consistent results for the incidence of recurrent ischemic stroke at 1 year were obtained in an analysis accounting for the competing risk of death (6.2%, 95% CI 4.8%-7.9%) and in a landmark analysis excluding the first 2 weeks after the index stroke and only including patients without permanent study drug discontinuation since then (6.8%, 95% CI 4.6%-8.9%).Conclusion Patients with AF and ischemic stroke while on oral anticoagulation are at increased risk of recurrent ischemic stroke and death. These patients currently have an unmet medical need. Key Question What is the risk of recurrent ischemic stroke and other outcomes in patients with atrial fibrillation who suffer an ischemic stroke while on warfarin or a direct oral anticoagulant? Key Finding In this COMBINE AF analysis of five randomized trials, the risk of ischemic stroke after a first post randomization stroke was 7.0% at 1 year. The risk of all-cause mortality at 3 months was 12.4%. Take Home Message Patients with atrial fibrillation and ischemic stroke while on oral anticoagulation are at increased risk of recurrent ischemic stroke and death. These patients currently have an unmet medical need.

Subject headings and genre

Added entries (persons, corporate bodies, meetings, titles ...)

  • Hohnloser, Stefan H.Goethe Univ Frankfurt, Dept Cardiol, Frankfurt, Germany (author)
  • Eikelboom, John W.McMaster Univ, Populat Hlth Res Inst, 237 Barton St E, Hamilton, ON L8L 2X2, Canada (author)
  • Carnicelli, Anthony P.Duke Univ, Duke Clin Res Inst, Durham, NC USA.;Med Univ South Carolina, Dept Med, Div Cardiol, Charleston, SC USA (author)
  • Giugliano, Robert P.Harvard Med Sch, Brigham & Womens Hosp, TIMI Study Grp, Boston, MA USA (author)
  • Granger, Christopher B.Duke Univ, Duke Clin Res Inst, Durham, NC USA (author)
  • Harrington, JosephineDuke Univ, Duke Clin Res Inst, Durham, NC USA (author)
  • Hijazi, ZiadUppsala universitet,Uppsala kliniska forskningscentrum (UCR),Kardiologi(Swepub:uu)ziahi940 (author)
  • Morrow, David A. (author)
  • Patel, Manesh R.Duke Univ, Duke Clin Res Inst, Durham, NC USA (author)
  • Seiffge, David J.Inselspital Univ Hosp, Dept Neurol, Bern, Switzerland.;Univ Bern, Bern, Switzerland (author)
  • Shoamanesh, Ashkan (author)
  • Wallentin, Lars,1943-Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)(Swepub:uu)larswall (author)
  • Yi, QilongUniv Ottawa, Sch Epidemiol & Publ Hlth, Ottawa, ON, Canada (author)
  • Connolly, Stuart J. (author)
  • McMaster Univ, Populat Hlth Res Inst, 237 Barton St E, Hamilton, ON L8L 2X2, Canada.;Johannes Gutenberg Univ Mainz, Univ Med Ctr Mainz, Dept Cardiol, Langenbeckstr 1, D-55131 Mainz, Rhineland Palat, GermanyGoethe Univ Frankfurt, Dept Cardiol, Frankfurt, Germany (creator_code:org_t)

Related titles

  • In:European Heart Journal: Oxford University Press44:20, s. 1807-18140195-668X1522-9645

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