Key result
Prior warfarin in AF stroke is linked to a 1-point lower median discharge mRS versus antiplatelets.
Why the study?
Cardioembolic stroke related to atrial fibrillation is associated with worse outcomes and higher intrahospital mortality, and the impact of prior antithrombotic therapy on outcome measures in patients with first-ever ischemic stroke and AF required evaluation.
Does prior antithrombotic therapy improve functional outcomes at discharge in patients with first-ever ischemic stroke and atrial fibrillation?
Cross-Sectional (n=754)
Does prior antithrombotic therapy improve functional outcomes at discharge in patients with first-ever ischemic stroke and atrial fibrillation?
Absolute Event Rate: 4% vs 5%
p-value: p=0.025
Prior warfarin therapy is associated with better functional outcomes at discharge in patients experiencing their first-ever AF-related ischemic stroke compared to antiplatelet or no antithrombotic therapy.
May support better discharge function with prior warfarin in AF stroke; observational data leave open need for randomized confirmation.
Background/Objectives: Atrial fibrillation (AF) is the most significant modifying risk factor for the development of cardioembolic stroke, which is associated with worse outcomes and higher intrahospital mortality compared to other types of ischemic stroke. Antithrombotic medications are administered as prophylactic treatment in patients with a risk of stroke. The aim of this study was to determine outcome measures in patients with first-ever ischemic stroke and AF regarding prior antithrombotic therapy. Methods: We collected data on stroke risk factors, CHADS2 score, and international normalized ratio (INR) value in the context of warfarin therapy, as well as data related to localization, stroke severity, and functional outcome at discharge. Results: A total of 754 subjects with first-ever ischemic stroke and AF were included in this cross-sectional study (122 on warfarin, 210 on acetylsalicylic acid, and 422 without prior antithrombotic therapy). The diagnosis of AF was previously unknown in 31% of the subjects. Stroke risk factors (arterial hypertension, hyperlipidemia, diabetes mellitus, and cardiomyopathy) were significantly lower in the group without prior antithrombotic therapy. The anticoagulant group was significantly younger (p = 0.001). Overall, 45.4% of subjects with a previously known AF event and a high risk of developing stroke received anticoagulant therapy. Participants on warfarin had a significantly better functional outcome than those on antiplatelet therapy or without prior antithrombotic therapy (median mRS 4 vs. 5 vs. 5; p = 0.025) and lower NIHSS scores, although the difference was not statistically significant (median 10 vs. 12 vs. 12; p = 0.09). There was no difference between stroke localization among groups (p = 0.116). Conclusions: Our study showed that, in our cohort, first-ever ischemic stroke due to AF was more common in women. Subjects on prior anticoagulant therapy had more favorable outcomes at discharge.
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Maduna et al. (2025) conducted a cross-sectional in First-ever ischemic stroke and atrial fibrillation (n=754). Warfarin vs. Acetylsalicylic acid or no prior antithrombotic therapy was evaluated on Functional outcome at discharge (median mRS) (p=0.025). Prior warfarin therapy in patients with first-ever ischemic stroke and AF improved functional outcomes at discharge compared to antiplatelet or no therapy (median mRS 4 vs 5; p=0.025).
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