Early Recurrence and Major Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation Treated With Non–Vitamin‐K Oral Anticoagulants (RAF‐NOACs) Study

Medientyp: E-Artikel
Titel: Early Recurrence and Major Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation Treated With Non–Vitamin‐K Oral Anticoagulants (RAF‐NOACs) Study
Beteiligte: Paciaroni, Maurizio; Agnelli, Giancarlo; Falocci, Nicola; Tsivgoulis, Georgios; Vadikolias, Kostantinos; Liantinioti, Chrysoula; Chondrogianni, Maria; Bovi, Paolo; Carletti, Monica; Cappellari, Manuel; Zedde, Marialuisa; Ntaios, George; Karagkiozi, Efstathia; Athanasakis, George; Makaritsis, Kostantinos; Silvestrelli, Giorgio; Lanari, Alessia; Ciccone, Alfonso; Putaala, Jukka; Tomppo, Liisa; Tatlisumak, Turgut; Abdul‐Rahim, Azmil H.; Lees, Kennedy R.; Alberti, Andrea; [...]
Erschienen: Ovid Technologies (Wolters Kluwer Health), 2017
Erschienen in: Journal of the American Heart Association
Sprache: Englisch
DOI: 10.1161/jaha.117.007034
ISSN: 2047-9980
Schlagwörter: Cardiology and Cardiovascular Medicine
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Beschreibung: <jats:sec xml:lang="en"> <jats:title>Background</jats:title> <jats:p xml:lang="en"> The optimal timing to administer non–vitamin K oral anticoagulants ( <jats:styled-content style="fixed-case">NOAC</jats:styled-content> s) 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 <jats:styled-content style="fixed-case">NOAC</jats:styled-content> s for secondary prevention. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Methods and Results</jats:title> <jats:p xml:lang="en"> 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 <jats:styled-content style="fixed-case">CHA</jats:styled-content> <jats:sub>2</jats:sub> <jats:styled-content style="fixed-case">DS</jats:styled-content> <jats:sub>2</jats:sub> ‐ <jats:styled-content style="fixed-case">VAS</jats:styled-content> c 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 <jats:styled-content style="fixed-case">NOAC</jats:styled-content> s 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. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Conclusions</jats:title> <jats:p xml:lang="en"> In patients with acute ischemic stroke and atrial fibrillation, treatment with <jats:styled-content style="fixed-case">NOAC</jats:styled-content> s was associated with a combined 5% rate of ischemic embolic recurrence and severe bleeding within 90 days. </jats:p> </jats:sec>
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