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Outcomes of patients with atrial fibrillation and ischemic stroke while on oral anticoagulation.

Publication ,  Journal Article
Benz, AP; Hohnloser, SH; Eikelboom, JW; Carnicelli, AP; Giugliano, RP; Granger, CB; Harrington, J; Hijazi, Z; Morrow, DA; Patel, MR; Yi, Q ...
Published in: Eur Heart J
May 21, 2023

AIMS: The prognosis of patients with atrial fibrillation (AF) and ischemic stroke while taking oral anticoagulation is poorly understood. This study aimed to characterize the outcomes of patients following a stroke event while on oral anticoagulation. METHODS AND RESULTS: Individual participant data from five pivotal randomized trials of antithrombotic therapy in AF were used to assess the outcomes of patients with a post-randomization ischemic stroke while on study medication (warfarin, standard-, or lower-dose direct oral anticoagulant regimen) during trial follow-up. The primary outcome was recurrent ischemic stroke after the first post-randomization ischemic stroke. The primary analysis included 1163 patients with a first post-randomization ischemic stroke while on study medication (median age 73 years, 39.3% female, 35.4% history of stroke before trial enrollment). During a median continued follow-up of 337 days, 74 patients had a recurrent ischemic stroke [cumulative incidence at 1 year: 7.0%, 95% confidence interval (CI) 5.2%-8.7%]. The cumulative incidence of mortality at 3 months after stroke was 12.4% (95% CI 10.5%-14.4%). Consistent results for the incidence of recurrent ischemic stroke at 1 year were obtained in an analysis accounting for the competing risk of death (6.2%, 95% CI 4.8%-7.9%) and in a landmark analysis excluding the first 2 weeks after the index stroke and only including patients without permanent study drug discontinuation since then (6.8%, 95% CI 4.6%-8.9%). CONCLUSION: Patients with AF and ischemic stroke while on oral anticoagulation are at increased risk of recurrent ischemic stroke and death. These patients currently have an unmet medical need.

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Published In

Eur Heart J

DOI

EISSN

1522-9645

Publication Date

May 21, 2023

Volume

44

Issue

20

Start / End Page

1807 / 1814

Location

England

Related Subject Headings

  • Treatment Outcome
  • Stroke
  • Risk Factors
  • Risk Assessment
  • Male
  • Ischemic Stroke
  • Humans
  • Female
  • Cardiovascular System & Hematology
  • Atrial Fibrillation
 

Citation

APA
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ICMJE
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Benz, A. P., Hohnloser, S. H., Eikelboom, J. W., Carnicelli, A. P., Giugliano, R. P., Granger, C. B., … Connolly, S. J. (2023). Outcomes of patients with atrial fibrillation and ischemic stroke while on oral anticoagulation. Eur Heart J, 44(20), 1807–1814. https://doi.org/10.1093/eurheartj/ehad200
Benz, Alexander P., Stefan H. Hohnloser, John W. Eikelboom, Anthony P. Carnicelli, Robert P. Giugliano, Christopher B. Granger, Josephine Harrington, et al. “Outcomes of patients with atrial fibrillation and ischemic stroke while on oral anticoagulation.Eur Heart J 44, no. 20 (May 21, 2023): 1807–14. https://doi.org/10.1093/eurheartj/ehad200.
Benz AP, Hohnloser SH, Eikelboom JW, Carnicelli AP, Giugliano RP, Granger CB, et al. Outcomes of patients with atrial fibrillation and ischemic stroke while on oral anticoagulation. Eur Heart J. 2023 May 21;44(20):1807–14.
Benz, Alexander P., et al. “Outcomes of patients with atrial fibrillation and ischemic stroke while on oral anticoagulation.Eur Heart J, vol. 44, no. 20, May 2023, pp. 1807–14. Pubmed, doi:10.1093/eurheartj/ehad200.
Benz AP, Hohnloser SH, Eikelboom JW, Carnicelli AP, Giugliano RP, Granger CB, Harrington J, Hijazi Z, Morrow DA, Patel MR, Seiffge DJ, Shoamanesh A, Wallentin L, Yi Q, Connolly SJ. Outcomes of patients with atrial fibrillation and ischemic stroke while on oral anticoagulation. Eur Heart J. 2023 May 21;44(20):1807–1814.
Journal cover image

Published In

Eur Heart J

DOI

EISSN

1522-9645

Publication Date

May 21, 2023

Volume

44

Issue

20

Start / End Page

1807 / 1814

Location

England

Related Subject Headings

  • Treatment Outcome
  • Stroke
  • Risk Factors
  • Risk Assessment
  • Male
  • Ischemic Stroke
  • Humans
  • Female
  • Cardiovascular System & Hematology
  • Atrial Fibrillation