The neurologist's approach to cerebral infarct and transient ischaemic attack in patients receiving anticoagulant treatment for non-valvular atrial fibrillation: ANITA-FA study

被引:12
作者
Zapata-Wainberg, G. [1 ]
Masjuan, J. [2 ]
Quintas, S. [1 ]
Ximenez-Carrillo, A. [1 ]
Garcia Pastor, A. [3 ]
Martinez Zabaleta, M. [4 ]
Cardona, P. [5 ]
Freijo Guerrero, M. M. [6 ]
Llull, L. [7 ]
Benavente Fernandez, L. [8 ]
Castellanos Rodrigo, M. [9 ]
Egido, J. [10 ]
Serena, J. [11 ]
Vivancos, J. [12 ]
机构
[1] Hosp Univ La Princesa, Inst Invest Sanitaria Princesa, Neurol Dept, Madrid, Spain
[2] Univ Alcala IRYCIS, Hosp Univ Raman & Cajal, Dept Med, Neurol Dept,Red INVICTUS PLUS, Madrid, Spain
[3] Univ Gregorio Maranon, Hosp Gen, Neurol Dept, Madrid, Spain
[4] Hosp Univ Donosti, Neurol Dept, Pais Vasco, Spain
[5] Hosp Univ Bellvitge, Neurol Dept, Barcelona, Spain
[6] Hosp Basurto, Neurol Dept, Bilbao, Spain
[7] Hosp Univ Clin, Neurol Dept, Barcelona, Spain
[8] Hosp Cent Oviedo, Neurol Dept, Oviedo, Spain
[9] Complejo Hosp Univ A Coruna, Neurol Dept, La Coruna, Spain
[10] Univ San Carlos, Hosp Clin, Madrid, Spain
[11] Hosp Univ Dr Josep Trueta, Neurol Dept, Girona, Spain
[12] Hosp Univ La Princesa, Red INVICTUS PLUS, Inst Invest Sanitaria La Princesa, Neurol Dept, Madrid, Spain
关键词
anticoagulant; direct-acting oral anticoagulants; medication; neuropharmacology; stroke; vitamin K antagonists; SECONDARY STROKE PREVENTION; DIRECT ORAL ANTICOAGULANTS; ANTITHROMBOTIC THERAPY; METAANALYSIS; THROMBOLYSIS; SATISFACTION; RIVAROXABAN; HEMORRHAGE; DABIGATRAN; MANAGEMENT;
D O I
10.1111/ene.13792
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and purpose The aim of this study was to describe the clinical and epidemiological characteristics of acute ischaemic stroke (AIS) in patients with atrial fibrillation (AF) previously treated with oral anticoagulants (OACs) according to the type of OAC prescribed. Also, to analyze the outcomes of the patients and the therapeutic approach adopted by the neurologist in the acute phase and for secondary prevention. Methods We performed a multicenter, observational study based on prospective registries. We included patients with AF treated with OACs admitted for AIS over a 1-year period. Detailed clinical data and functional outcome at 3 months (modified Rankin Scale score) were collected. Patients were divided into two groups according to their pre-AIS anticoagulant therapy: vitamin K antagonists (AIS-VKA) and direct-acting OACs (AIS-DOAC). Results We recruited 1240 patients (80.4% AIS-VKA and 19.6% AIS-DOAC). In the AIS-DOAC group, transient ischaemic attack was more frequent (18.1% vs. 10.8%; P = 0.001), symptomatic hemorrhagic transformation was less frequent (1.6% vs. 4.6%; P = 0.035) and hospital stay was shorter (median 6 vs. 7 days; P = 0.03). Intravenous thrombolysis was more commonly used in AIS-VKA (9.2% vs. 1.6%; P < 0.001). There were no differences between the groups with respect to mechanical thrombectomy, mortality and modified Rankin Scale score at 3 months. At 3 months, 54% of patients required a DOAC as antithrombotic treatment for secondary prevention. Conclusions Patients with AF treated with DOACs who experienced AIS more frequently had transient symptoms (transient ischaemic attack), less symptomatic hemorrhagic transformation and a shorter mean stay than those treated with VKAs. Most patients who had been previously anticoagulated with AIS received long-term treatment with DOACs.
引用
收藏
页码:230 / 237
页数:8
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