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Echocardiographic Risk Factors for Stroke and Outcomes in Patients With Atrial Fibrillation Anticoagulated With Apixaban or Warfarin.

Publication ,  Journal Article
Vinereanu, D; Lopes, RD; Mulder, H; Gersh, BJ; Hanna, M; de Barros E Silva, PGM; Atar, D; Wallentin, L; Granger, CB; Alexander, JH ...
Published in: Stroke
December 2017

BACKGROUND AND PURPOSE: Few data exist on the long-term outcomes of patients with spontaneous echo contrast (SEC), left atrial/left atrial appendage (LA/LAA) thrombus, and complex aortic plaque (CAP), in patients with atrial fibrillation receiving oral anticoagulation. We explored the relationship between these 3 echocardiographic findings and clinical outcomes, and the comparative efficacy and safety of apixaban and warfarin for each finding. METHODS: Patients from the ARISTOTLE trial (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) with SEC, LA/LAA thrombus, or CAP diagnosed by either transthoracic or transesophageal echocardiography were compared with patients with none of these findings on transesophageal echocardiography. RESULTS: A total of 1251 patients were included: 217 had SEC, 127 had LA/LAA thrombus, 241 had CAP, and 746 had none. The rates of stroke/systemic embolism were not significantly different among patients with and without these echocardiographic findings (hazard ratio, 0.96; 95% confidence interval, 0.25-3.60 for SEC; hazard ratio, 1.27; 95% confidence interval, 0.23-6.86 for LA/LAA thrombus; hazard ratio, 2.21; 95% confidence interval, 0.71-6.85 for CAP). Rates of ischemic stroke, myocardial infarction, cardiovascular death, and all-cause death were also not different between patients with and without these findings. For patients with either SEC or CAP, there was no evidence of a differential effect of apixaban over warfarin. For patients with LA/LAA thrombus, there was also no significant interaction, with the exception of all-cause death and any bleeding where there was a greater benefit of apixaban compared with warfarin among patients with no LA/LAA thrombus. CONCLUSIONS: In anticoagulated patients with atrial fibrillation and risk factors for stroke, echocardiographic findings do not seem to add to the risk of thromboembolic events. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00412984.

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Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

December 2017

Volume

48

Issue

12

Start / End Page

3266 / 3273

Location

United States

Related Subject Headings

  • Warfarin
  • Treatment Outcome
  • Thromboembolism
  • Stroke
  • Risk Factors
  • Pyridones
  • Pyrazoles
  • Plaque, Atherosclerotic
  • Neurology & Neurosurgery
  • Myocardial Infarction
 

Citation

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Vinereanu, D., Lopes, R. D., Mulder, H., Gersh, B. J., Hanna, M., de Barros E Silva, P. G. M., … ARISTOTLE Investigators, . (2017). Echocardiographic Risk Factors for Stroke and Outcomes in Patients With Atrial Fibrillation Anticoagulated With Apixaban or Warfarin. Stroke, 48(12), 3266–3273. https://doi.org/10.1161/STROKEAHA.117.017574
Vinereanu, Dragos, Renato D. Lopes, Hillary Mulder, Bernard J. Gersh, Michael Hanna, Pedro G. M. de Barros E Silva, Dan Atar, et al. “Echocardiographic Risk Factors for Stroke and Outcomes in Patients With Atrial Fibrillation Anticoagulated With Apixaban or Warfarin.Stroke 48, no. 12 (December 2017): 3266–73. https://doi.org/10.1161/STROKEAHA.117.017574.
Vinereanu D, Lopes RD, Mulder H, Gersh BJ, Hanna M, de Barros E Silva PGM, et al. Echocardiographic Risk Factors for Stroke and Outcomes in Patients With Atrial Fibrillation Anticoagulated With Apixaban or Warfarin. Stroke. 2017 Dec;48(12):3266–73.
Vinereanu, Dragos, et al. “Echocardiographic Risk Factors for Stroke and Outcomes in Patients With Atrial Fibrillation Anticoagulated With Apixaban or Warfarin.Stroke, vol. 48, no. 12, Dec. 2017, pp. 3266–73. Pubmed, doi:10.1161/STROKEAHA.117.017574.
Vinereanu D, Lopes RD, Mulder H, Gersh BJ, Hanna M, de Barros E Silva PGM, Atar D, Wallentin L, Granger CB, Alexander JH, ARISTOTLE Investigators. Echocardiographic Risk Factors for Stroke and Outcomes in Patients With Atrial Fibrillation Anticoagulated With Apixaban or Warfarin. Stroke. 2017 Dec;48(12):3266–3273.

Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

December 2017

Volume

48

Issue

12

Start / End Page

3266 / 3273

Location

United States

Related Subject Headings

  • Warfarin
  • Treatment Outcome
  • Thromboembolism
  • Stroke
  • Risk Factors
  • Pyridones
  • Pyrazoles
  • Plaque, Atherosclerotic
  • Neurology & Neurosurgery
  • Myocardial Infarction