Timing to start anticoagulants after acute ischemic stroke with non-valvular atrial fibrillation
| Autor: | Fahd Ali Al Khmais, Erum M. Shariff, Aishah Ibrahim Al Bakr, Reem S AlOmar, Kawther Hadhiah, Danah Aljaafari, Majed Alabdali, Azra Zafar, Mona A.F. Nada, Noman Ishaque, Hanan Khalid Ahabib, Alaa Mohsin Al Majed, Rizwana Shahid |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Non valvular atrial fibrillation Saudi Arabia Infarction Early initiation Brain Ischemia Time-to-Treatment Cohort Studies 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine Atrial Fibrillation medicine Humans cardiovascular diseases 030212 general & internal medicine Prospective Studies Stroke Acute ischemic stroke Aged Ischemic Stroke business.industry Warfarin Anticoagulants Atrial fibrillation Middle Aged medicine.disease Neurology Female Neurology (clinical) business Intracranial Hemorrhages 030217 neurology & neurosurgery medicine.drug Cohort study |
| Zdroj: | Journal of the neurological sciences. 409 |
| ISSN: | 1878-5883 |
| Popis: | Objective To identify timing for initiation of anticoagulation therapy in acute ischemic stroke (AIS) with non-valvular AF as regards safety and efficacy by detecting the rate of intracranial haemorrhage (ICH) and recurrent ischemic symptoms (RIS) during follow-up. Methods This is a prospective observational cohort study conducted at King Fahd Hospital of the University including 120 patients with AIS/TIAs from July 2016 till July 2018. We compared patients who received anticoagulants 1–6 days (Group I (45.83%), 7–14 days, Group II (35%), and > 14 days after the ischemic event (Group III (19.17%). Follow-up was at least 3 months and included identifying ICH or RIS. Result ICH has occurred in 26.67% (n = 32) patients with a highly statistically significant association with time of treatment (P-value = .01) being higher in group I (n = 17) compared to only 1 case in group III. Subgroup analyses on the ICH patients (n = 32) has revealed statistical significant association with higher NIHSS score (P = .001). Also, the type of anticoagulants used between three groups pointed to an association existence (p = .02), however, the direction of this association cannot be determined. There was no statistical significant association between RIS (occurred in 4.16% (n = 5) with time of treatment (P = .754). Functional outcome at 3–6 months measured by mRS did not differ between 3 groups (worst mRS in group I). Conclusion Early initiation of anticoagulation after stroke, especially in cases of large infarction, is associated with significant risk of ICH. This risk is highest with warfarin and lowest with DOAC. |
| Databáze: | OpenAIRE |
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