Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease (Dec 2017)

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

  • Maurizio Paciaroni,
  • Giancarlo Agnelli,
  • Nicola Falocci,
  • Georgios Tsivgoulis,
  • Kostantinos Vadikolias,
  • Chrysoula Liantinioti,
  • Maria Chondrogianni,
  • Paolo Bovi,
  • Monica Carletti,
  • Manuel Cappellari,
  • Marialuisa Zedde,
  • George Ntaios,
  • Efstathia Karagkiozi,
  • George Athanasakis,
  • Kostantinos Makaritsis,
  • Giorgio Silvestrelli,
  • Alessia Lanari,
  • Alfonso Ciccone,
  • Jukka Putaala,
  • Liisa Tomppo,
  • Turgut Tatlisumak,
  • Azmil H. Abdul‐Rahim,
  • Kennedy R. Lees,
  • Andrea Alberti,
  • Michele Venti,
  • Monica Acciarresi,
  • Cataldo D'Amore,
  • Cecilia Becattini,
  • Maria Giulia Mosconi,
  • Ludovica Anna Cimini,
  • Rossana Soloperto,
  • Luca Masotti,
  • Vieri Vannucchi,
  • Gianni Lorenzini,
  • Rossana Tassi,
  • Francesca Guideri,
  • Maurizio Acampa,
  • Giuseppe Martini,
  • Sung‐Il Sohn,
  • Simona Marcheselli,
  • Nicola Mumoli,
  • Maria Luisa De Lodovici,
  • Giorgio Bono,
  • Karen L. Furie,
  • Prasanna Tadi,
  • Shadi Yaghi,
  • Danilo Toni,
  • Federica Letteri,
  • Tiziana Tassinari,
  • Odysseas Kargiotis,
  • Enrico Maria Lotti,
  • Yuriy Flomin,
  • Michelangelo Mancuso,
  • Miriam Maccarrone,
  • Nicola Giannini,
  • Fabio Bandini,
  • Alessandro Pezzini,
  • Loris Poli,
  • Alessandro Padovani,
  • Umberto Scoditti,
  • Licia Denti,
  • Domenico Consoli,
  • Franco Galati,
  • Simona Sacco,
  • Antonio Carolei,
  • Cindy Tiseo,
  • Vanessa Gourbali,
  • Giovanni Orlandi,
  • Martina Giuntini,
  • Alberto Chiti,
  • Elisa Giorli,
  • Gino Gialdini,
  • Francesco Corea,
  • Walter Ageno,
  • Marta Bellesini,
  • Giovanna Colombo,
  • Serena Monaco,
  • Mario Maimone Baronello,
  • Theodore Karapanayiotides,
  • Valeria Caso

DOI
https://doi.org/10.1161/JAHA.117.007034
Journal volume & issue
Vol. 6, no. 12

Abstract

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BackgroundThe 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 ResultsRecurrence 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. ConclusionsIn 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.

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