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Early Recurrence and Major Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation Treated With Non-Vitamin-K Oral Anticoagulants (RAF-NOACs) Study

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Author(s)
Maurizio PaciaroniGiancarlo AgnelliNicola FalocciGeorgios TsivgoulisKostantinos VadikoliasChrysoula LiantiniotiMaria ChondrogianniPaolo BoviMonica CarlettiManuel CappellariMarialuisa ZeddeGeorge NtaiosEfstathia KaragkioziGeorge AthanasakisKostantinos MakaritsisGiorgio SilvestrelliAlessia LanariAlfonso CicconeJukka PutaalaLiisa TomppoTurgut TatlisumakAzmil H. Abdul-RahimKennedy R. LeesAndrea AlbertiMichele VentiMonica AcciarresiCataldo D’AmoreCecilia BecattiniMaria Giulia MosconiLudovica Anna CiminiRossana SolopertoLuca MasottiVieri VannucchiGianni LorenziniFrancesca GuideriMaurizio AcampaGiuseppe MartiniSung-Il SohnSimona MarcheselliNicola MumoliMaria Luisa De LodoviciGiorgio BonoKaren L. FuriePrasanna TadiShadi YaghiDanilo ToniFederica LetteriTiziana TassinariOdysseas KargiotisEnrico Maria LottiYuriy FlominMichelangelo MancusoMiriam MaccarroneNicola GianniniFabio BandiniAlessandro PezziniLoris PoliAlessandro PadovaniUmberto ScodittiLicia DentiDomenico ConsoliFranco GalatiSimona SaccoAntonio CaroleiCindy TiseoVanessa GourbaliGiovanni OrlandiMartina GiuntiniAlberto ChitiElisa GiorliGino GialdiniFrancesco CoreaWalter AgenoMarta BellesiniGiovanna ColomboSerena MonacoMario Maimone BaronelloTheodore KarapanayiotidesValeria CasoRossana Tassi
Keimyung Author(s)
Sohn, Sung Il
Department
Dept. of Neurology (신경과학)
Journal Title
Journal of American Heart Association
Issued Date
2017
Volume
6
Issue
12
Keyword
secondary preventionatrial fibrillationacute strokeanticoagulants
Abstract
BACKGROUND:

The optimal timing to administer non-vitamin K oral anticoagulants (NOACs) in patients with acute ischemic stroke and atrial fibrillation is unclear. This prospective observational multicenter study evaluated the rates of early recurrence and major bleeding (within 90 days) and their timing in patients with acute ischemic stroke and atrial fibrillation who received NOACs for secondary prevention.

METHODS AND RESULTS:

Recurrence was defined as the composite of ischemic stroke, transient ischemic attack, and symptomatic systemic embolism, and major bleeding was defined as symptomatic cerebral and major extracranial bleeding. For the analysis, 1127 patients were eligible: 381 (33.8%) were treated with dabigatran, 366 (32.5%) with rivaroxaban, and 380 (33.7%) with apixaban. Patients who received dabigatran were younger and had lower admission National Institutes of Health Stroke Scale score and less commonly had a CHA2DS2-VASc score >4 and less reduced renal function. Thirty-two patients (2.8%) had early recurrence, and 27 (2.4%) had major bleeding. The rates of early recurrence and major bleeding were, respectively, 1.8% and 0.5% in patients receiving dabigatran, 1.6% and 2.5% in those receiving rivaroxaban, and 4.0% and 2.9% in those receiving apixaban. Patients who initiated NOACs within 2 days after acute stroke had a composite rate of recurrence and major bleeding of 12.4%; composite rates were 2.1% for those who initiated NOACs between 3 and 14 days and 9.1% for those who initiated >14 days after acute stroke.

CONCLUSIONS:

In patients with acute ischemic stroke and atrial fibrillation, treatment with NOACs was associated with a combined 5% rate of ischemic embolic recurrence and severe bleeding within 90 days.
Keimyung Author(s)(Kor)
손성일
Publisher
School of Medicine (의과대학)
Citation
Maurizio Paciaroni et al. (2017). Early Recurrence and Major Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation Treated With Non-Vitamin-K Oral Anticoagulants (RAF-NOACs) Study. Journal of American Heart Association, 6(12), e007034–e007034. doi: 10.1161/JAHA.117.007034
Type
Article
ISSN
2047-9980
DOI
10.1161/JAHA.117.007034
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/41203
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Neurology (신경과학)
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