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Garcia C, Silva M, Araújo M, Henriques M, Margarido M, Vicente P, Nzwalo H, Macedo A. Admission Severity of Atrial-Fibrillation-Related Acute Ischemic Stroke in Patients under Anticoagulation Treatment: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:3563. [PMID: 35743633 PMCID: PMC9225527 DOI: 10.3390/jcm11123563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/08/2022] [Accepted: 06/15/2022] [Indexed: 02/04/2023] Open
Abstract
Background: In non-valvular-associated atrial fibrillation (AF), direct oral anticoagulants (DOAC) are as effective as vitamin K antagonists (VKA) for the prevention of acute ischemic stroke (AIS). DOAC are associated with decreased risk and severity of intracranial hemorrhage. It is unknown if different pre-admission anticoagulants impact the prognosis of AF related AIS (AF-AIS). We sought to analyze the literature to assess the association between pre-admission anticoagulation (VKA or DOAC) and admission severity of AF-AIS. Methods: A Systematic literature search (PubMed and ScienceDirect) between January 2011 to April 2021 was undertaken to identify studies describing the outcome of AF-AIS. Results: A total of 128 articles were identified. Of 9493 patients, 1767 were on DOAC, 919 were on therapeutical VKA, 792 were on non-therapeutical VKA and 6015 were not anticoagulated. In comparison to patients without anticoagulation, patients with therapeutical VKA and under DOAC presented with less severe stroke (MD −1.69; 95% CI [−2.71, −0.66], p = 0.001 and MD −2.96; 95% Cl [−3.75, −2.18], p < 0.00001, respectively). Patients with non-therapeutical VKA presented with more severe stroke (MD 1.28; 95% Cl [0.45, 2.12], p = 0.003). Conclusions: In AF-AIS, patients under therapeutical VKA or DOAC have reduced stroke severity on admission in comparison to patients without any anticoagulation, with higher magnitude of protection for DOAC.
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Affiliation(s)
- Catarina Garcia
- Faculty of Medicine and Biomedical Sciences, University of Algarve, 8005-139 Faro, Portugal; (C.G.); (M.S.); (M.A.); (M.H.); (M.M.); (P.V.); (A.M.)
| | - Marcelo Silva
- Faculty of Medicine and Biomedical Sciences, University of Algarve, 8005-139 Faro, Portugal; (C.G.); (M.S.); (M.A.); (M.H.); (M.M.); (P.V.); (A.M.)
| | - Mariana Araújo
- Faculty of Medicine and Biomedical Sciences, University of Algarve, 8005-139 Faro, Portugal; (C.G.); (M.S.); (M.A.); (M.H.); (M.M.); (P.V.); (A.M.)
| | - Mariana Henriques
- Faculty of Medicine and Biomedical Sciences, University of Algarve, 8005-139 Faro, Portugal; (C.G.); (M.S.); (M.A.); (M.H.); (M.M.); (P.V.); (A.M.)
| | - Marta Margarido
- Faculty of Medicine and Biomedical Sciences, University of Algarve, 8005-139 Faro, Portugal; (C.G.); (M.S.); (M.A.); (M.H.); (M.M.); (P.V.); (A.M.)
| | - Patrícia Vicente
- Faculty of Medicine and Biomedical Sciences, University of Algarve, 8005-139 Faro, Portugal; (C.G.); (M.S.); (M.A.); (M.H.); (M.M.); (P.V.); (A.M.)
| | - Hipólito Nzwalo
- Faculty of Medicine and Biomedical Sciences, University of Algarve, 8005-139 Faro, Portugal; (C.G.); (M.S.); (M.A.); (M.H.); (M.M.); (P.V.); (A.M.)
- Algarve Biomedical Center, 8005-139 Algarve, Portugal
- Stroke Unit, Algarve University Hospital Center, 8000-386 Algarve, Portugal
| | - Ana Macedo
- Faculty of Medicine and Biomedical Sciences, University of Algarve, 8005-139 Faro, Portugal; (C.G.); (M.S.); (M.A.); (M.H.); (M.M.); (P.V.); (A.M.)
- Algarve Biomedical Center, 8005-139 Algarve, Portugal
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Srisilpa S, Korathanakhun P. Predictors of clinical outcome among Thai patients with atrial fibrillation-associated acute ischemic stroke. J Stroke Cerebrovasc Dis 2020; 29:104856. [PMID: 32389560 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/11/2020] [Accepted: 03/28/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To investigate the predictors of 3-month death among an atrial fibrillation-associated acute ischemic stroke (AF-stroke). METHODS This retrospective cohort study was conducted at a university hospital in Thailand. Patients with AF-stroke admitted between 2012 and 2017 were enrolled into the study. Baseline characteristics, clinical presentations, complications, and outcomes measured by the modified Rankin scale were collected from electronic medical records. Predictors of death outcomes were analyzed by univariate and multivariate logistic regression analysis. RESULTS The mortality rate among 119 AF-stroke patients was 26.89%. The independent predictors of 3-month death were developing AKI during hospitalization (adjusted odds ratio [aOR] = 6.38, 95% CI = 1.96-20.76, p = 0.001) and age above 75 years old (aOR = 3.08, 95% CI = 1.17-8.13, p = 0.019). In contrast, receiving treatment with an oral anticoagulant prior to the stroke episode was a protective factor (aOR = 0.13, 95% CI = 0.03-0.64, p = 0.002). CONCLUSION Developing AKI and older age were the independent predictor of 3- month death among AF-stroke patients.
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Affiliation(s)
- Song Srisilpa
- Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Pat Korathanakhun
- Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
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Zhu J, Ma M, Guo Y, Zhou M, Guo J, He L. Pre-stroke warfarin enhancement of collateralization in acute ischemic stroke: a retrospective study. BMC Neurol 2018; 18:194. [PMID: 30497406 PMCID: PMC6263562 DOI: 10.1186/s12883-018-1200-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/19/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Warfarin therapies not only are used to prevent stroke in patients with high risk of cardioembolism such as patients with atrial fibrillation (AF) and rheumatic heart disease (RHD), but also was associated with lower stroke severity and more favorable functional outcomes in patients with acute ischemic stroke due to middle cerebral artery occlusion. It was speculated that pre-stroke warfarin may promote collateralization and result in reduced stroke severity. This study aimed to investigate the association between pre-stroke warfarin use and leptomeningeal collaterals in patients with acute ischemic stroke due to occlusion of the middle cerebral artery. METHODS We enrolled consecutive acute ischemic stroke patients (occlusion of the middle cerebral artery within 24 h) with known history of AF and/or RHD at the neurology department of the West China Hospital from May 2011 to April 2017. Computed tomography angiography (CTA) before treatment was used to detect the thrombus. Regional leptomeningeal collateral (rLMC) score based on CTA images was used to assess collateral circulation. Prior use of warfarin was recorded. Univariate and multivariate analyses were performed to detect the association of prior warfarin use with the collateral circulation. RESULTS A total of 120 patients were included; 29 (24.2%) were taking warfarin before stroke. The international normalized ratio (INR) in patients with prior warfarin use was 1.53 ± 1.00, compared with 1.02 ± 0.09 in patients without prior warfarin use (P < 0.001). Prior oral warfarin therapy was inversely associated with poor rLMC (OR = 0.07, 95%CI 0.01-0.44, P = 0.005). There were no associations between prior warfarin use and initial stroke severity or functional outcomes at 3 months. CONCLUSION Warfarin use seems improve collateralization in patients with acute stroke. However, clinical controlled studies should be used to verify this claim.
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Affiliation(s)
- Jiaying Zhu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.,Department of Emergency, Gui Zhou provincial People's Hospital, Guiyang, China
| | - Mengmeng Ma
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yijia Guo
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Muke Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Jian Guo
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Li He
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
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Chang SS, Wu JH, Liu Y, Zhang T, Du X, Dong JZ, Lip GYH, Ma CS. In-hospital direct costs for thromboembolism and bleeding in Chinese patients with atrial fibrillation. Chronic Dis Transl Med 2018; 4:127-134. [PMID: 29988956 PMCID: PMC6033953 DOI: 10.1016/j.cdtm.2018.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Indexed: 01/07/2023] Open
Abstract
Objective Limited data are available on the direct costs of hospitalization owing to thromboembolism and bleeding in patients with atrial fibrillation (AF) in China. Such data are essential for policy development, service planning, and cost-effectiveness analysis of new therapeutic strategies. This study aimed to provide detailed data regarding in-hospital direct costs for these patients, compare the costs at different scenarios, and identify independent factors that may predict the costs. Methods We collected data regarding in-hospital direct costs among patients with AF who were hospitalized owing to ischemic stroke (IS), transient ischemic attack (TIA), intracranial hemorrhage (ICH), or major gastrointestinal bleeding. All data were collected from 7 representative tertiary referral hospitals and 3 secondary care hospitals from December 2009 to October 2014. Results In total, 312 eligible patients with thromboembolism and 143 patients with major bleeding were identified, and their hospital charts were reviewed. The median in-hospital direct costs were 17,857 Chinese Yuan (CNY) for IS and 16,589 CNY for TIA (equivalent to 2907 US dollars and 2701 US dollars, respectively). For patients with major bleeding, the costs were 27,924 CNY for ICH and 18,196 CNY for major gastrointestinal bleeding (equivalent to 4546 US dollars and 2962 US dollars, respectively). The direct costs were mainly driven by medications, which accounted for approximately 33.4%–36.1% in different groups of patients. The direct costs were highly related to the hospital level and National Institutes of Health Stroke Scale scores in patients with thromboembolism; in patients with ICH, the factors included hospital level, warfarin treatment before admission, and prior hospitalization for stroke. Conclusions Given the high prevalence, AF-related thromboembolism and bleeding impose considerable economic burden on the Chinese society. Efforts to improve the management of AF may confer substantial economic benefits.
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Affiliation(s)
- San-Shuai Chang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - Jia-Hui Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - Yi Liu
- Department of Cardiology, Xuzhou Center Hospital, Xuzhou, Jiangsu 221000, China
| | - Ting Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - Jian-Zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - Gregory Y H Lip
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham B18 7QH, United Kingdom
| | - Chang-Sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
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Impact of pre-admission treatment with non-vitamin K oral anticoagulants on stroke severity in patients with acute ischemic stroke. J Thromb Thrombolysis 2018; 45:529-535. [DOI: 10.1007/s11239-018-1634-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Cerasuolo JO, Montero-Odasso M, Ibañez A, Doocy S, Lip GYH, Sposato LA. Decision-making interventions to stop the global atrial fibrillation-related stroke tsunami. Int J Stroke 2017; 12:222-228. [DOI: 10.1177/1747493016687579] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Atrial fibrillation affects 33.5 million people worldwide and its prevalence is expected to double by 2050 because of the aging population. Atrial fibrillation confers a 5-fold higher risk of ischemic stroke compared to sinus rhythm. We present our view of the role of shared medical decision-making to combat global underutilization of oral anticoagulation for stroke prevention in atrial fibrillation patients. Oral anticoagulation underuse is widespread as it is present within atrial fibrillation patients of all risk strata and in countries across all income levels. Reasons for oral anticoagulation underuse include but are probably not limited to poor risk stratification, over-interpretation of contraindications, and discordance between physician prescription preferences and actual administration. By comparing a catastrophic event to the consequences of atrial fibrillation related strokes, it may help physicians and patients understand the negative outcomes associated with oral anticoagulation under-utilization and the magnitude to which oral anticoagulations neutralize atrial fibrillation burden.
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Affiliation(s)
- Joshua O Cerasuolo
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Manuel Montero-Odasso
- Gait and Brain Lab, Parkwood Hospital and Lawson Health Research Institute, London, ON, Canada
- Department of Medicine, Division of Geriatric Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Epidemiology & Biostatistics, Schulich Interfaculty Program in Public Health, Western University, London, ON, Canada
| | - Agustin Ibañez
- Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, National Scientific and Technical Research Council, Buenos Aires, Argentina
- Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibanez, Santiago de Chile, Chile
- Centre of Excellence in Cognition and its Disorders, Australian Research Council (ARC), New South Wales, Australia
- Universidad Autónoma del Caribe, Barranquilla, Colombia
| | - Shannon Doocy
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gregory YH Lip
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - Luciano A Sposato
- Department of Clinical Neurological Sciences, Department of Anatomy and Cell Biology, London Health Sciences Centre, Western University, London, ON, Canada
- London Stroke, Dementia & Heart Disease Laboratory, Western University, London, ON, Canada
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