Carotid atherosclerosis and risk for ischemic stroke in patients with atrial fibrillation on oral anticoagulant treatment
| Autor: | Giuseppe Camporese, Cecilia Becattini, Seena Padayattil, Giancarlo Agnelli, Elena Rancan, Giorgia Manina, Agnese Sembolini, Chiara Tonello, Francesco Dentali |
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| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Male
Carotid atherosclerosis medicine.medical_specialty Time Factors Administration Oral 030204 cardiovascular system & hematology Risk Assessment Brain Ischemia Anticoagulants Atrial fibrillation Carotid stenosis Stroke Cardiology and Cardiovascular Medicine 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine Prevalence Humans Medicine In patient Prospective Studies cardiovascular diseases Prospective cohort study Aged Aged 80 and over business.industry Ultrasonography Doppler Middle Aged medicine.disease Stenosis Treatment Outcome Italy Ischemic Attack Transient Ischemic stroke Cardiology Oral anticoagulant Female business 030217 neurology & neurosurgery |
| Popis: | Background and aims Whether carotid atherosclerosis is associated with an increased risk for ischemic stroke in patients with atrial fibrillation (AF) on anticoagulant treatment is undefined. To explore this association, patients with AF on treatment with vitamin K antagonists were included in a multicenter, prospective study. Methods At inclusion in the study, patients underwent Doppler-ultrasonography for the assessment of carotid atherosclerosis and then were prospectively followed. Ischemic stroke or transient ischemic attack (TIA) were the primary study outcomes; death and its causes were reported. Results Overall, 587 patients were included in the study. At ultrasonography, 380 patients had carotid atherosclerosis (64.7%) and 45 internal carotid (ICA) stenosis ≥50% (7.7%). During a mean follow-up of 41 ± 15 months, 30 patients had an ischemic stroke or TIA (1.49% per patient-year, 95% CI 0.96–2.03) and 81 patients died (4.01% per patient-year, 95% CI 3.16–4.86). Carotid atherosclerosis was associated with a significant increase in the risk for the composite of ischemic stroke or TIA or death after adjusting for CHA2DS2VASc (6.0% vs. 3.1% patient-year; HR 1.60, 95% CI 0.99–2.59; p = 0.05). ICA ≥50% was associated with a not significant increase in the risk of ischemic stroke or TIA (2.05% vs. 1.45% patient-year; HR 1.39, 95% CI 0.42–4.58) or all-cause death (6.1% vs. 3.8% patient-year; HR 1.66, 95% CI 0.83–3.32). Conclusions In patients with AF, carotid atherosclerosis is a predictor for the composite of cerebrovascular events or death while on anticoagulant therapy. In patients with AF and carotid atherosclerosis, the clinical benefit of a more intense antithrombotic treatment should be evaluated. |
| Databáze: | OpenAIRE |
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