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

• Published in: Journal of the American Heart Association Vol. 6; no. 12
• Main Authors: Paciaroni, Maurizio, Agnelli, Giancarlo, Falocci, Nicola, Tsivgoulis, Georgios, Vadikolias, Kostantinos, Liantinioti, Chrysoula, Chondrogianni, Maria, Bovi, Paolo, Carletti, Monica, Cappellari, Manuel, Zedde, Marialuisa, Ntaios, George, Karagkiozi, Efstathia, Athanasakis, George, Makaritsis, Kostantinos, Silvestrelli, Giorgio, Lanari, Alessia, Ciccone, Alfonso, Putaala, Jukka, Tomppo, Liisa, Tatlisumak, Turgut, Abdul‐Rahim, Azmil H., Lees, Kennedy R., Alberti, Andrea, Venti, Michele, Acciarresi, Monica, D'Amore, Cataldo, Becattini, Cecilia, Mosconi, Maria Giulia, Cimini, Ludovica Anna, Soloperto, Rossana, Masotti, Luca, Vannucchi, Vieri, Lorenzini, Gianni, Tassi, Rossana, Guideri, Francesca, Acampa, Maurizio, Martini, Giuseppe, Sohn, Sung‐Il, Marcheselli, Simona, Mumoli, Nicola, De Lodovici, Maria Luisa, Bono, Giorgio, Furie, Karen L., Tadi, Prasanna, Yaghi, Shadi, Toni, Danilo, Letteri, Federica, Tassinari, Tiziana, Kargiotis, Odysseas, Lotti, Enrico Maria, Flomin, Yuriy, Mancuso, Michelangelo, Maccarrone, Miriam, Giannini, Nicola, Bandini, Fabio, Pezzini, Alessandro, Poli, Loris, Padovani, Alessandro, Scoditti, Umberto, Denti, Licia, Consoli, Domenico, Galati, Franco, Sacco, Simona, Carolei, Antonio, Tiseo, Cindy, Gourbali, Vanessa, Orlandi, Giovanni, Giuntini, Martina, Chiti, Alberto, Giorli, Elisa, Gialdini, Gino, Corea, Francesco, Ageno, Walter, Bellesini, Marta, Colombo, Giovanna, Monaco, Serena, Maimone Baronello, Mario, Karapanayiotides, Theodore, Caso, Valeria
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 01.12.2017; Wiley
• Subjects: Acute Disease; acute stroke; Administration, Oral; Aged; Aged, 80 and over; anticoagulants; Anticoagulants - therapeutic use; arterial; association; atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - drug therapy; Brain Ischemia - epidemiology; Brain Ischemia - prevention & control; Cardiac and Cardiovascular Systems; Cardiovascular System & Cardiology; Dabigatran - administration & dosage; Dabigatran - adverse effects; Dose-Response Relationship, Drug; early management; Female; Follow-Up Studies; guidelines; health-care professionals; Hemorrhage - chemically induced; Hemorrhage - epidemiology; hemorrhagic transformation; human brain; Humans; Incidence; Kardiologi; Male; Middle Aged; Original Research; Prospective Studies; Pyrazoles - administration & dosage; Pyrazoles - adverse effects; Pyridones - administration & dosage; Pyridones - adverse effects; Recurrence; Rivaroxaban - administration & dosage; Rivaroxaban - adverse effects; secondary prevention; Survival Rate - trends; task-force; territories; Time Factors; Treatment Outcome; Vitamin K - antagonists & inhibitors; warfarin; writing committee; anticoagulants; atrial fibrillation; acute stroke; secondary prevention
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.117.007034

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.