Secondary stroke prevention in people with atrial fibrillation: treatments and trials.

Autor:	Seiffge DJ; Department of Neurology, Inselspital University Hospital Bern and University of Bern, Switzerland. Electronic address: david.seiffge@insel.ch., Cancelloni V; Stroke Unit, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy., Räber L; Department of Cardiology, Inselspital University Hospital Bern and University of Bern, Switzerland., Paciaroni M; Stroke Unit, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy., Metzner A; Department of Cardiology, University Heart and Vascular Center Hamburg, University Center Hamburg Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research, partner site Hamburg, Kiel, and Lübeck, Germany., Kirchhof P; Department of Cardiology, University Heart and Vascular Center Hamburg, University Center Hamburg Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research, partner site Hamburg, Kiel, and Lübeck, Germany; Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK., Fischer U; Department of Neurology, Inselspital University Hospital Bern and University of Bern, Switzerland; Department of Neurology, University Hospital Basel, Switzerland., Werring DJ; Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK., Shoamanesh A; Division of Neurology, Department of Medicine, Population Health Research Institute, McMaster University, Hamilton, ON, Canada., Caso V; Stroke Unit, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy.
Jazyk:	angličtina
Zdroj:	The Lancet. Neurology [Lancet Neurol] 2024 Apr; Vol. 23 (4), pp. 404-417.
DOI:	10.1016/S1474-4422(24)00037-1
Abstrakt:	Atrial fibrillation is one of the most common cardiac arrhythmias and is a major cause of ischaemic stroke. Recent findings indicate the importance of atrial fibrillation burden (device-detected, subclinical, or paroxysmal and persistent or permanent) and whether atrial fibrillation was known before stroke onset or diagnosed after stroke for the risk of recurrence. Secondary prevention in patients with atrial fibrillation and stroke aims to reduce the risk of recurrent ischaemic stroke. Findings from randomised controlled trials assessing the optimal timing to introduce direct oral anticoagulant therapy after a stroke show that early start (ie, within 48 h for minor to moderate strokes and within 4-5 days for large strokes) seems safe and could reduce the risk of early recurrence. Other promising developments regarding early rhythm control, left atrial appendage occlusion, and novel factor XI inhibitor oral anticoagulants suggest that these therapies have the potential to further reduce the risk of stroke. Secondary prevention strategies in patients with atrial fibrillation who have a stroke despite oral anticoagulation therapy is an unmet medical need. Research advances suggest a heterogeneous spectrum of causes, and ongoing trials are investigating new approaches for secondary prevention in this vulnerable patient group. In patients with atrial fibrillation and a history of intracerebral haemorrhage, the latest data from randomised controlled trials on stroke prevention shows that oral anticoagulation reduces the risk of ischaemic stroke but more data are needed to define the safety profile. Competing Interests: Declaration of interests DJS reports advisory board roles with Portola/Alexion, Bayer AG Switzerland, Javeline, Bioxodes, and VarmX and research funding from Bangerter Rhyner Foundation and the Swiss National Science Foundation (all paid to employer and used for academic research funding). LR reports research grants paid to institution by Abbott, Biotronik, BostonScientific, Sanofi, Infraredx, Regeneron, and the Swiss National Science Foundation; speaker fees from Abbott, Amgen, Occlutech, Medtronic, Novo Nordisc, and Sanof; and stocks from Shockwave and Verve Therapeutics. MP received honoraria as a member of the speaker bureau of Sanofi-Aventis, BMS, Daiiki Sankyo, and Pfizer. PK was partially supported by EU AFFECT-AF (grant agreement 847770), BigData@Heart (grant agreement EU IMI 116074), and MAESTRIA (grant agreement 965286), the British Heart Foundation (PG/20/22/35093; AA/18/2/34218), German Center for Cardiovascular Research supported by the German Ministry of Education and Research (DZHK, grant numbers DZHK FKZ 81X2800182, 81Z0710116, and 81Z0710110), and Leducq Foundation; receives research support for basic, translational, and clinical research projects from European Union, British Heart Foundation, Leducq Foundation, Medical Research Council (UK), and German Centre for Cardiovascular Research, from several drug and device companies active in atrial fibrillation (has received honoraria from several such companies in the past, but not in the last three years); is listed as inventor on two issued patents held by University of Hamburg (Atrial Fibrillation Therapy WO 2015140571, Markers for Atrial Fibrillation WO 2016012783); and is a Board member of the European Society of Cardiology, Speaker of the Board, AFNET. UF reports research support from the Swiss National Science Foundation and Swiss Heart Foundation; research grants from Medtronic, Stryker, Penumbra, Rapid Medical, Phenox, and Boehringer Ingelheim; consultancy fees for Medtronic, Stryker, and CSL Behring (fees paid to institution); participation in an advisory board for Alexion/Portola and Boehringer Ingelheim (fees paid to institution); membership of a clinical event committee of the COATING study (Phenox), data and safety monitoring committee of the TITAN, LATE-MT, RapidPulse, and IN EXTREMIS trials, and advisory boards for Alexion/Portola, Boehringer Ingelheim, Biogen, and Acthera; and presidency of the Swiss Neurological Society. DJW reports honoraria (speaking) from Bayer 2022 (talks or debates on anticoagulants, intracerebral haemorrhage, atrial fibrillation, and dementia); consultancy fees from Alnylam (2019) and NovoNordisk (2021); and chief investigator role on the OPTIMAS trial of early DOAC treatment after ischaemic stroke (BHF funded). AS reports participation in advisory boards for AstraZeneca, Bayer AG, Daiichi Sankyo, and Servier Canada and research funding from the Canadian Institute of Health Research, Heart and Stroke Foundation of Canada, Marta and Owen Boris Foundation, National Institues of Aging, National Institutes of Health, AstraZeneca, Bayer, Daiichi Sankyo, Javelin Medical, Servier Canada, and Bristol-Myers Squibb. VaC reports advisory boards and speaker fees from Boehringer-Ingelheim, Pfizer/BMS, Bayer, Mindmaze, Daiichi Sankyo, and Ever-NeuroPharma. ViC and AM declare no competing interests. (Copyright © 2024 Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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