BACKGROUND AND PURPOSE: Oral anticoagulation (OAC) is an effective preventive therapy for ischemic stroke in atrial fibrillation (AF). The management of anticoagulation in AF patients with previous intracerebral hemorrhage (ICH) is challenging. The aim of this study was to determine the prevalence of AF after acute ICH in a consecutive monocenter cohort, and to document the subsequent management with respect to OAC. METHODS: Consecutive patients with spontaneous ICH were prospectively included within 19 months. Diagnosis of AF was based on medical history, 12-lead electrocardiogram (ECG), 24-h and continuous ECG monitoring. CHADS₂ scores and patient medication were recorded at admission and after 3 months. Additionally, after 3 months mortality, the management of anticoagulation and a newly detected AF were assessed. RESULTS: In total, 206 ICH patients were eligible for data analysis. After 3 months, AF had been diagnosed in 64/206 ICH patients (31.1%). Mortality after 3 months was higher in patients with AF in univariate analysis (45.3% vs. 31.0%). After adjusting for comorbidities and OAC use, AF did not remain an independent predictor for mortality. In total, 35 patients with AF survived 3 months. Of these, CHADS₂ score was 2 (2/3, median, interquartile range (IQR)) and 27/35 patients had an indication for OAC with respect to the CHADS₂ score, but only 25.7% had been (re-)started on OAC. No consistent factors for deciding whether to initiate OAC treatment could be identified. CONCLUSIONS: Atrial fibrillation is a frequent comorbidity in patients suffering an ICH. Our findings underline the prevailing uncertainty regarding the anticoagulation management of AF after ICH.
BACKGROUND AND PURPOSE: Oral anticoagulation (OAC) is an effective preventive therapy for ischemic stroke in atrial fibrillation (AF). The management of anticoagulation in AFpatients with previous intracerebral hemorrhage (ICH) is challenging. The aim of this study was to determine the prevalence of AF after acute ICH in a consecutive monocenter cohort, and to document the subsequent management with respect to OAC. METHODS: Consecutive patients with spontaneous ICH were prospectively included within 19 months. Diagnosis of AF was based on medical history, 12-lead electrocardiogram (ECG), 24-h and continuous ECG monitoring. CHADS₂ scores and patient medication were recorded at admission and after 3 months. Additionally, after 3 months mortality, the management of anticoagulation and a newly detected AF were assessed. RESULTS: In total, 206 ICHpatients were eligible for data analysis. After 3 months, AF had been diagnosed in 64/206 ICHpatients (31.1%). Mortality after 3 months was higher in patients with AF in univariate analysis (45.3% vs. 31.0%). After adjusting for comorbidities and OAC use, AF did not remain an independent predictor for mortality. In total, 35 patients with AF survived 3 months. Of these, CHADS₂ score was 2 (2/3, median, interquartile range (IQR)) and 27/35 patients had an indication for OAC with respect to the CHADS₂ score, but only 25.7% had been (re-)started on OAC. No consistent factors for deciding whether to initiate OAC treatment could be identified. CONCLUSIONS:Atrial fibrillation is a frequent comorbidity in patients suffering an ICH. Our findings underline the prevailing uncertainty regarding the anticoagulation management of AF after ICH.
Authors: Jochen A Sembill; Claudia Y Wieser; Maximilian I Sprügel; Stefan T Gerner; Antje Giede-Jeppe; Caroline Reindl; Ilker Y Eyüpoglu; Philip Hoelter; Hannes Lücking; Joji B Kuramatsu; Hagen B Huttner Journal: J Neurol Date: 2018-08-20 Impact factor: 4.849
Authors: Eleni Korompoki; Filippos T Filippidis; Peter B Nielsen; Angela Del Giudice; Gregory Y H Lip; Joji B Kuramatsu; Hagen B Huttner; Jiming Fang; Sam Schulman; Joan Martí-Fàbregas; Celine S Gathier; Anand Viswanathan; Alessandro Biffi; Daniela Poli; Christian Weimar; Uwe Malzahn; Peter Heuschmann; Roland Veltkamp Journal: Neurology Date: 2017-07-19 Impact factor: 9.910
Authors: Andreas Charidimou; Toshio Imaizumi; Solene Moulin; Alexandro Biffi; Neshika Samarasekera; Yusuke Yakushiji; Andre Peeters; Yves Vandermeeren; Patrice Laloux; Jean-Claude Baron; Mar Hernandez-Guillamon; Joan Montaner; Barbara Casolla; Simone M Gregoire; Dong-Wha Kang; Jong S Kim; H Naka; Eric E Smith; Anand Viswanathan; Hans R Jäger; Rustam Al-Shahi Salman; Steven M Greenberg; Charlotte Cordonnier; David J Werring Journal: Neurology Date: 2017-07-26 Impact factor: 9.910
Authors: Ana Lopez-de-Andres; Rodrigo Jimenez-Garcia; Valentín Hernández-Barrera; Isabel Jiménez-Trujillo; José M de Miguel-Yanes; David Carabantes-Alarcon; Javier de Miguel-Diez; Marta Lopez-Herranz Journal: Cardiovasc Diabetol Date: 2021-07-09 Impact factor: 9.951