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Ischaemic stroke on anticoagulation therapy and early recurrence in acute cardioembolic stroke: the IAC study

Authors :
M. Edip Gurol
Karen L. Furie
Iman Moeini-Naghani
Angela Liu
Tushar Trivedi
Eva Mistry
Adam de Havenon
Daniyal Asad
Salah G. Keyrouz
Heather Martin
Ava L. Liberman
Kiersten Espaillat
Khadean Moncrieffe
Jose Tan
Ashutosh Kaushal
Erica Scher
Idrees Azher
Natalie Cheng
Charles Esenwa
Muhammad Nagy
Mithilesh Siddu
Brian Mac Grory
James A Giles
Manivannan Veerasamy
Hemanth Pasupuleti
Muhib Khan
Christopher R. Leon Guerrero
Amre Nouh
Shadi Yaghi
Eric E. Smith
Hiba Fakhri
Nils Henninger
Source :
Journal of Neurology, Neurosurgery & Psychiatry. 92:1062-1067
Publication Year :
2021
Publisher :
BMJ, 2021.

Abstract

Background and purposeA subset of ischaemic stroke patients with atrial fibrillation (AF) have ischaemic stroke despite anticoagulation. We sought to determine the association between prestroke anticoagulant therapy and recurrent ischaemic events and symptomatic intracranial haemorrhage (sICH).MethodsWe included consecutive patients with acute ischaemic stroke and AF from the Initiation of Anticoagulation after Cardioembolic stroke (IAC) study from eight comprehensive stroke centres in the USA. We compared recurrent ischaemic events and delayed sICH risk using adjusted Cox regression analyses between patients who were prescribed anticoagulation (ACp) versus patients who were naïve to anticoagulation therapy prior to the ischaemic stroke (anticoagulation naïve).ResultsAmong 2084 patients in IAC, 1518 had prior anticoagulation status recorded and were followed for 90 days. In adjusted Cox hazard models, ACp was associated with some evidence of a higher risk higher risk of 90-day recurrent ischaemic events only in the fully adjusted model (adjusted HR 1.50, 95% CI 0.99 to 2.28, p=0.058) but not increased risk of 90-day sICH (adjusted HR 1.08, 95% CI 0.46 to 2.51, p=0.862). In addition, switching anticoagulation class was not associated with reduced risk of recurrent ischaemic events (adjusted HR 0.41, 95% CI 0.12 to 1.33, p=0.136) nor sICH (adjusted HR 1.47, 95% CI 0.29 to 7.50, p=0.641).ConclusionAF patients with ischaemic stroke despite anticoagulation may have higher recurrent ischaemic event risk compared with anticoagulation-naïve patients. This suggests differing underlying pathomechanisms requiring different stroke prevention measures and identifying these mechanisms may improve secondary prevention strategies.

Details

ISSN :
1468330X and 00223050
Volume :
92
Database :
OpenAIRE
Journal :
Journal of Neurology, Neurosurgery & Psychiatry
Accession number :
edsair.doi.dedup.....b3d5e4ecc0bf1cb3c6cd8fd77bb6ab2f
Full Text :
https://doi.org/10.1136/jnnp-2021-326166