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The neurologist's approach to cerebral infarct and transient ischaemic attack in patients receiving anticoagulant treatment for non‐valvular atrial fibrillation: ANITA ‐ FA study
Author(s) -
ZapataWainberg G.,
Masjuan J.,
Quintas S.,
XiménezCarrillo Á.,
García Pastor A.,
Martínez Zabaleta M.,
Cardona P.,
Freijo Guerrero M. M.,
Llull L.,
Benavente Fernández L.,
Castellanos Rodrigo M.,
Egido J.,
Serena J.,
Vivancos J.
Publication year - 2019
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.13792
Subject(s) - medicine , atrial fibrillation , thrombolysis , modified rankin scale , antithrombotic , vitamin k antagonist , stroke (engine) , cardiology , anticoagulant , prospective cohort study , fibrinolytic agent , ischemic stroke , myocardial infarction , warfarin , ischemia , mechanical engineering , engineering
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 ( OAC s) 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 OAC s 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 OAC s ( 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 DOAC s who experienced AIS more frequently had transient symptoms (transient ischaemic attack), less symptomatic hemorrhagic transformation and a shorter mean stay than those treated with VKA s. Most patients who had been previously anticoagulated with AIS received long‐term treatment with DOAC s.