Association of improved outcome in acute ischaemic stroke patients with atrial fibrillation who receive early antithrombotic therapy: analysis from VISTA
- 16 October 2014
- journal article
- research article
- Published by Wiley in European Journal of Neurology
- Vol. 22 (7), 1048-1055
- https://doi.org/10.1111/ene.12577
Abstract
Background and purpose Ischaemic stroke patients with atrial fibrillation (AF) are at risk of early recurrent stroke (RS). However, antithrombotics commenced at the acute stage may exacerbate haemorrhagic transformation, provoking symptomatic intracerebral haemorrhage (SICH). The relevance of antithrombotics on the patterns and outcome of the cohort was investigated. Methods A non‐randomized cohort analysis was conducted using data obtained from VISTA (Virtual International Stroke Trials Archive). The associations of antithrombotics with the modified Rankin Scale (mRS) outcome and the occurrence of RS and SICH (each as a combined end‐point of fatal and non‐fatal events) at 90 days for post‐stroke patients with AF were described. Dichotomized outcomes were also considered as a secondary end‐point (i.e. mortality and good outcome measure at 90 days). Results In all, 1644 patients were identified; 1462 (89%) received antithrombotics, 157 (10%) had RS and 50 (3%) sustained SICH by day 90. Combined antithrombotic therapy (i.e. anticoagulants and antiplatelets), 782 (48%), was associated with favourable outcome on ordinal mRS and a significantly lower risk of RS, SICH and mortality by day 90, compared with the no antithrombotics group. The relative risk of RS and SICH appeared highest in the first 2 days post‐stroke before attenuating to become constant over time. Conclusions The risks and benefits of antithrombotics in recent stroke patients with AF appear to track together. Early introduction of anticoagulants (2–3 days post‐stroke), and to a lesser extent antiplatelet agents, was associated with substantially fewer RS events over the following weeks but with no excess risk of SICH. More evidence is required to guide clinicians on this issue.This publication has 26 references indexed in Scilit:
- Targeted use of heparin, heparinoids, or low-molecular-weight heparin to improve outcome after acute ischaemic stroke: an individual patient data meta-analysis of randomised controlled trialsThe Lancet Neurology, 2013
- Guidelines for the Early Management of Patients With Acute Ischemic StrokeStroke, 2013
- New Frontiers for Stroke Prevention in Atrial FibrillationCerebrovascular Diseases, 2012
- Asymptomatic Hemorrhagic Transformation of Infarction and Its Relationship With Functional Outcome and Stroke SubtypeStroke, 2010
- Early Recurrent Ischemic Stroke Complicating Intravenous Thrombolysis for StrokeStroke, 2010
- Early Hemorrhagic Transformation of Brain Infarction: Rate, Predictive Factors, and Influence on Clinical OutcomeStroke, 2008
- Guidelines for Management of Ischaemic Stroke and Transient Ischaemic Attack 2008Cerebrovascular Diseases, 2008
- Efficacy and Safety of Anticoagulant Treatment in Acute Cardioembolic StrokeStroke, 2007
- Stroke prevention with aspirin, warfarin and ximelagatran in patients with non-valvular atrial fibrillation: A systematic review and meta-analysisThrombosis Research, 2006
- Atrial fibrillation as an independent risk factor for stroke: the Framingham Study.Stroke, 1991