David J Seiffge1, Christopher Traenka2, Alexandros Polymeris2, Lisa Hert2, Nils Peters2, Philippe Lyrer2, Stefan T Engelter2, Leo H Bonati2, Gian Marco De Marchis2. 1. From the Department of Neurology and Stroke Center (D.J.S., C.T., A.P., L.H., N.P., P.L., S.T.E., L.H.B., G.M.D.M.), University Hospital of Basel; University of Basel (D.J.S.); and Neurorehabilitation Unit (S.T.E.), University of Basel and University Center for Medicine of Aging, Felix Platter Hospital, Basel, Switzerland. david.seiffge@usb.ch. 2. From the Department of Neurology and Stroke Center (D.J.S., C.T., A.P., L.H., N.P., P.L., S.T.E., L.H.B., G.M.D.M.), University Hospital of Basel; University of Basel (D.J.S.); and Neurorehabilitation Unit (S.T.E.), University of Basel and University Center for Medicine of Aging, Felix Platter Hospital, Basel, Switzerland.
Abstract
OBJECTIVE: In patients with recent acute ischemic stroke (AIS) and atrial fibrillation, we assessed the starting time of direct, non-vitamin K antagonist oral anticoagulants (DOACs) for secondary prevention, the rate of intracranial hemorrhage (ICH), and recurrent ischemic events during follow-up. METHODS: We included consecutive patients with nonvalvular atrial fibrillation admitted to our hospital for AIS or TIA (index event) who received secondary prophylaxis with DOAC or vitamin K antagonists (VKAs). Follow-up was at least 3 months. In the primary analysis, we compared rates of ICH and recurrent ischemic events (AIS or TIA) between patients with early (≤7 days since event; DOACearly) and those with late (>7 days, DOAClate) start of DOAC. RESULTS: Two hundred four patients were included (median age 79 years, 89% AIS) and total follow-up time was 78.25 patient-years. One hundred fifty-five patients received DOAC with a median delay of 5 days after the index event (interquartile range 3-11) and 49 received VKA. DOAC was started early in 100 patients (65%). We observed one ICH (1.3%/y) and 6 recurrent AIS (7.7%/y). The ICH occurred in a patient taking VKA. No significant difference in the rate of recurrent AIS between DOACearly (5.1%/y) and DOAClate (9.3%/y, p = 0.53) was observed. CONCLUSIONS: Even if DOACs are often started early after an index event, the risk of ICH appears to be low. Among all patients receiving anticoagulation, the rate of recurrent events was 6 times higher than the rate of ICH.
OBJECTIVE: In patients with recent acute ischemic stroke (AIS) and atrial fibrillation, we assessed the starting time of direct, non-vitamin K antagonist oral anticoagulants (DOACs) for secondary prevention, the rate of intracranial hemorrhage (ICH), and recurrent ischemic events during follow-up. METHODS: We included consecutive patients with nonvalvular atrial fibrillation admitted to our hospital for AIS or TIA (index event) who received secondary prophylaxis with DOAC or vitamin K antagonists (VKAs). Follow-up was at least 3 months. In the primary analysis, we compared rates of ICH and recurrent ischemic events (AIS or TIA) between patients with early (≤7 days since event; DOACearly) and those with late (>7 days, DOAClate) start of DOAC. RESULTS: Two hundred four patients were included (median age 79 years, 89% AIS) and total follow-up time was 78.25 patient-years. One hundred fifty-five patients received DOAC with a median delay of 5 days after the index event (interquartile range 3-11) and 49 received VKA. DOAC was started early in 100 patients (65%). We observed one ICH (1.3%/y) and 6 recurrent AIS (7.7%/y). The ICH occurred in a patient taking VKA. No significant difference in the rate of recurrent AIS between DOACearly (5.1%/y) and DOAClate (9.3%/y, p = 0.53) was observed. CONCLUSIONS: Even if DOACs are often started early after an index event, the risk of ICH appears to be low. Among all patients receiving anticoagulation, the rate of recurrent events was 6 times higher than the rate of ICH.
Authors: Paula R Sanches; Mohammad Tabaeizadeh; Lidia M V R Moura; Eric S Rosenthal; Luis Otavio Caboclo; John Hsu; Elisabetta Patorno; M Brandon Westover; Sahar F Zafar Journal: Neurol Sci Date: 2022-06-17 Impact factor: 3.830
Authors: Alexandros A Polymeris; Annaelle Zietz; Fabian Schaub; Louisa Meya; Christopher Traenka; Sebastian Thilemann; Benjamin Wagner; Lisa Hert; Valerian L Altersberger; David J Seiffge; Flurina Lyrer; Tolga Dittrich; Ines Piot; Josefin Kaufmann; Lea Barone; Ludvig Dahlheim; Sophie Flammer; Nikolaos S Avramiotis; Nils Peters; Gian Marco De Marchis; Leo H Bonati; Henrik Gensicke; Stefan T Engelter; Philippe A Lyrer Journal: Eur Stroke J Date: 2022-05-10
Authors: Lisa Hert; Alexandros A Polymeris; Sabine Schaedelin; Johanna Lieb; David J Seiffge; Christopher Traenka; Joachim Fladt; Sebastian Thilemann; Henrik Gensicke; Gian Marco De Marchis; Leo Bonati; Philippe Lyrer; Stefan T Engelter; Nils Peters Journal: Eur Stroke J Date: 2019-11-12