Association of improved outcome in acute ischaemic stroke patients with atrial fibrillation who receive early antithrombotic therapy

Analysis from VISTA

for the VISTA collaborators

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Background and purpose: Ischaemic stroke patients with atrial fibrillation (AF) are at risk of early recurrent stroke (RS). However, antithrombotics commenced at the acute stage may exacerbate haemorrhagic transformation, provoking symptomatic intracerebral haemorrhage (SICH). The relevance of antithrombotics on the patterns and outcome of the cohort was investigated. Methods: A non-randomized cohort analysis was conducted using data obtained from VISTA (Virtual International Stroke Trials Archive). The associations of antithrombotics with the modified Rankin Scale (mRS) outcome and the occurrence of RS and SICH (each as a combined end-point of fatal and non-fatal events) at 90 days for post-stroke patients with AF were described. Dichotomized outcomes were also considered as a secondary end-point (i.e. mortality and good outcome measure at 90 days). Results: In all, 1644 patients were identified; 1462 (89%) received antithrombotics, 157 (10%) had RS and 50 (3%) sustained SICH by day 90. Combined antithrombotic therapy (i.e. anticoagulants and antiplatelets), 782 (48%), was associated with favourable outcome on ordinal mRS and a significantly lower risk of RS, SICH and mortality by day 90, compared with the no antithrombotics group. The relative risk of RS and SICH appeared highest in the first 2 days post-stroke before attenuating to become constant over time. Conclusions: The risks and benefits of antithrombotics in recent stroke patients with AF appear to track together. Early introduction of anticoagulants (2-3 days post-stroke), and to a lesser extent antiplatelet agents, was associated with substantially fewer RS events over the following weeks but with no excess risk of SICH. More evidence is required to guide clinicians on this issue.

Original languageEnglish (US)
Pages (from-to)1048-1055
Number of pages8
JournalEuropean Journal of Neurology
Volume22
Issue number7
DOIs
StatePublished - Jul 1 2015
Externally publishedYes

Fingerprint

Secondary Prevention
Atrial Fibrillation
Stroke
Cerebral Hemorrhage
Anticoagulants
Mortality
Platelet Aggregation Inhibitors
Cohort Studies
Outcome Assessment (Health Care)

Keywords

  • Antithrombotics
  • Atrial fibrillation
  • Intracerebral haemorrhage
  • Stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Medicine(all)

Cite this

Association of improved outcome in acute ischaemic stroke patients with atrial fibrillation who receive early antithrombotic therapy : Analysis from VISTA. / for the VISTA collaborators.

In: European Journal of Neurology, Vol. 22, No. 7, 01.07.2015, p. 1048-1055.

Research output: Contribution to journalArticle

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title = "Association of improved outcome in acute ischaemic stroke patients with atrial fibrillation who receive early antithrombotic therapy: Analysis from VISTA",
abstract = "Background and purpose: Ischaemic stroke patients with atrial fibrillation (AF) are at risk of early recurrent stroke (RS). However, antithrombotics commenced at the acute stage may exacerbate haemorrhagic transformation, provoking symptomatic intracerebral haemorrhage (SICH). The relevance of antithrombotics on the patterns and outcome of the cohort was investigated. Methods: A non-randomized cohort analysis was conducted using data obtained from VISTA (Virtual International Stroke Trials Archive). The associations of antithrombotics with the modified Rankin Scale (mRS) outcome and the occurrence of RS and SICH (each as a combined end-point of fatal and non-fatal events) at 90 days for post-stroke patients with AF were described. Dichotomized outcomes were also considered as a secondary end-point (i.e. mortality and good outcome measure at 90 days). Results: In all, 1644 patients were identified; 1462 (89{\%}) received antithrombotics, 157 (10{\%}) had RS and 50 (3{\%}) sustained SICH by day 90. Combined antithrombotic therapy (i.e. anticoagulants and antiplatelets), 782 (48{\%}), was associated with favourable outcome on ordinal mRS and a significantly lower risk of RS, SICH and mortality by day 90, compared with the no antithrombotics group. The relative risk of RS and SICH appeared highest in the first 2 days post-stroke before attenuating to become constant over time. Conclusions: The risks and benefits of antithrombotics in recent stroke patients with AF appear to track together. Early introduction of anticoagulants (2-3 days post-stroke), and to a lesser extent antiplatelet agents, was associated with substantially fewer RS events over the following weeks but with no excess risk of SICH. More evidence is required to guide clinicians on this issue.",
keywords = "Antithrombotics, Atrial fibrillation, Intracerebral haemorrhage, Stroke",
author = "{for the VISTA collaborators} and Abdul-Rahim, {A. H.} and Fulton, {R. L.} and B. Frank and T. Tatlisumak and M. Paciaroni and V. Caso and Diener, {H. C.} and Lees, {K. R.} and Alexandrov, {A. V.} and Bath, {P. W.} and E. Bluhmki and L. Claesson and J. Curram and Davis, {S. M.} and G. Donnan and Diener, {H. C.} and M. Fisher and B. Gregson and J. Grotta and W. Hacke and Hennerici, {M. G.} and M. Hommel and M. Kaste and {Lees Chair}, {K. R.} and P. Lyden and J. Marler and K. Muir and Sacco, {Ralph L} and A. Shuaib and P. Teal and Wahlgren, {N. G.} and S. Warach and C. Weimar",
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T1 - Association of improved outcome in acute ischaemic stroke patients with atrial fibrillation who receive early antithrombotic therapy

T2 - Analysis from VISTA

AU - for the VISTA collaborators

AU - Abdul-Rahim, A. H.

AU - Fulton, R. L.

AU - Frank, B.

AU - Tatlisumak, T.

AU - Paciaroni, M.

AU - Caso, V.

AU - Diener, H. C.

AU - Lees, K. R.

AU - Alexandrov, A. V.

AU - Bath, P. W.

AU - Bluhmki, E.

AU - Claesson, L.

AU - Curram, J.

AU - Davis, S. M.

AU - Donnan, G.

AU - Diener, H. C.

AU - Fisher, M.

AU - Gregson, B.

AU - Grotta, J.

AU - Hacke, W.

AU - Hennerici, M. G.

AU - Hommel, M.

AU - Kaste, M.

AU - Lees Chair, K. R.

AU - Lyden, P.

AU - Marler, J.

AU - Muir, K.

AU - Sacco, Ralph L

AU - Shuaib, A.

AU - Teal, P.

AU - Wahlgren, N. G.

AU - Warach, S.

AU - Weimar, C.

PY - 2015/7/1

Y1 - 2015/7/1

N2 - Background and purpose: Ischaemic stroke patients with atrial fibrillation (AF) are at risk of early recurrent stroke (RS). However, antithrombotics commenced at the acute stage may exacerbate haemorrhagic transformation, provoking symptomatic intracerebral haemorrhage (SICH). The relevance of antithrombotics on the patterns and outcome of the cohort was investigated. Methods: A non-randomized cohort analysis was conducted using data obtained from VISTA (Virtual International Stroke Trials Archive). The associations of antithrombotics with the modified Rankin Scale (mRS) outcome and the occurrence of RS and SICH (each as a combined end-point of fatal and non-fatal events) at 90 days for post-stroke patients with AF were described. Dichotomized outcomes were also considered as a secondary end-point (i.e. mortality and good outcome measure at 90 days). Results: In all, 1644 patients were identified; 1462 (89%) received antithrombotics, 157 (10%) had RS and 50 (3%) sustained SICH by day 90. Combined antithrombotic therapy (i.e. anticoagulants and antiplatelets), 782 (48%), was associated with favourable outcome on ordinal mRS and a significantly lower risk of RS, SICH and mortality by day 90, compared with the no antithrombotics group. The relative risk of RS and SICH appeared highest in the first 2 days post-stroke before attenuating to become constant over time. Conclusions: The risks and benefits of antithrombotics in recent stroke patients with AF appear to track together. Early introduction of anticoagulants (2-3 days post-stroke), and to a lesser extent antiplatelet agents, was associated with substantially fewer RS events over the following weeks but with no excess risk of SICH. More evidence is required to guide clinicians on this issue.

AB - Background and purpose: Ischaemic stroke patients with atrial fibrillation (AF) are at risk of early recurrent stroke (RS). However, antithrombotics commenced at the acute stage may exacerbate haemorrhagic transformation, provoking symptomatic intracerebral haemorrhage (SICH). The relevance of antithrombotics on the patterns and outcome of the cohort was investigated. Methods: A non-randomized cohort analysis was conducted using data obtained from VISTA (Virtual International Stroke Trials Archive). The associations of antithrombotics with the modified Rankin Scale (mRS) outcome and the occurrence of RS and SICH (each as a combined end-point of fatal and non-fatal events) at 90 days for post-stroke patients with AF were described. Dichotomized outcomes were also considered as a secondary end-point (i.e. mortality and good outcome measure at 90 days). Results: In all, 1644 patients were identified; 1462 (89%) received antithrombotics, 157 (10%) had RS and 50 (3%) sustained SICH by day 90. Combined antithrombotic therapy (i.e. anticoagulants and antiplatelets), 782 (48%), was associated with favourable outcome on ordinal mRS and a significantly lower risk of RS, SICH and mortality by day 90, compared with the no antithrombotics group. The relative risk of RS and SICH appeared highest in the first 2 days post-stroke before attenuating to become constant over time. Conclusions: The risks and benefits of antithrombotics in recent stroke patients with AF appear to track together. Early introduction of anticoagulants (2-3 days post-stroke), and to a lesser extent antiplatelet agents, was associated with substantially fewer RS events over the following weeks but with no excess risk of SICH. More evidence is required to guide clinicians on this issue.

KW - Antithrombotics

KW - Atrial fibrillation

KW - Intracerebral haemorrhage

KW - Stroke

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DO - 10.1111/ene.12577

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JO - European Journal of Neurology

JF - European Journal of Neurology

SN - 1351-5101

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