AI Article Synopsis
- The study investigates post-stroke antithrombotic therapy patterns in patients with atrial fibrillation and how these treatments impact outcomes after ischemic stroke.
- Among patients who were not taking anticoagulants before their stroke, many continued to forgo anticoagulation or only received antiplatelet medications, resulting in higher rates of recurrent strokes and mortality compared to those on non-vitamin K antagonist oral anticoagulants (NOACs).
- Continuing the same NOAC after a stroke was linked to better outcomes, while switching NOACs increased the risk of ischemic stroke, indicating that maintaining consistency in anticoagulant therapy may be crucial for patient safety and recovery.
Article Abstract
Background: The impact of post-stroke antithrombotic regimen in atrial fibrillation is uncertain.
Objective: This study aimed to describe antithrombotic therapy prescribing patterns after ischemic stroke and the impact on outcomes.
Methods: A total of 23,165 patients with atrial fibrillation experiencing ischemic stroke were identified. Subsequent post-stroke events included recurrent ischemic stroke, intracranial hemorrhage, major bleeding, mortality, and composite outcomes.
Results: Of those who were nonanticoagulated before a stroke, 33.5% remained nonanticoagulated and 39.2% were prescribed only antiplatelet agents (APs) after a stroke. Compared with non-vitamin K antagonist oral anticoagulants (NOACs) after stroke, there was a significant increase in ischemic stroke and mortality in nonanticoagulated patients (adjusted hazard ratio [aHR], 2.09 and 3.92) and AP users (aHR, 1.32 and 1.28). Post-stroke warfarin was associated with a significantly increased risk of major bleeding compared with NOACs (aHR, 1.23). Of 769 patients receiving NOACs before stroke and continuing NOACs after stroke, those switching to a different NOAC were associated with significantly higher risk of ischemic stroke (aHR, 2.07) and composite outcomes (aHR, 1.36-1.85) with no difference in intracranial hemorrhage, major bleeding, or mortality compared with those receiving the same NOAC after stroke. Of patients receiving NOACs before stroke, the risks of clinical events were similar between patients taking NOACs alone and those taking NOAC plus AP after stroke.
Conclusion: NOAC alone after stroke was associated with a better clinical outcome compared with nonanticoagulation, AP, or warfarin. Of patients already taking NOACs before stroke, the addition of AP did not confer additional benefits compared with NOACs alone. A change of NOAC types after stroke was associated with a 2-fold higher risk of ischemic stroke and composite outcomes.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.hrthm.2024.07.115 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!